Parenting in a Pandemic: Preliminary Support for Delivering Brief Behavioral Parent Training Through Telehealth.

Behavioral problems, such as noncompliance and aggression, are a common referral reason to mental health services for young children. Behavioral parent training (BPT) is the leading intervention for addressing behavioral problems and leads to benefits in a variety of parental factors (e.g., parenting efficacy and parenting stress). While the COVID-19 pandemic dramatically shifted service delivery toward telehealth services, limited work has evaluated the effectiveness of BPT when delivered in a brief, group format through telehealth. The current retrospective chart review study evaluated the engagement to and preliminary effectiveness of a brief version of BPT delivered through telehealth to 64 families of 3- to 7-year-olds referred for behavioral problems. Families attended an average of 4.55 of 6 sessions and most families had two caregivers who engaged in the intervention. Significant reductions in caregivers' report of children's behavioral problems and improvements in parenting self-efficacy resulted. Future research and clinical implications are discussed.

Predicting children's differential trajectories of emotion dysregulation: A study on the intergenerational transmission of child and caregiver maltreatment.

BACKGROUND: Child maltreatment and caregiver history of abuse is negatively associated with the development of emotion regulation, and maltreatment in early childhood may be particularly disruptive. OBJECTIVE: We examined patterns of emotion dysregulation and the contribution of caregiver victimization and early maltreatment history on the development of distinct emotion dysregulation trajectories. PARTICIPANTS: The current study sample (n = 1354) came from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a longitudinal study of the antecedents and consequences of child maltreatment. Children had a varied risk of maltreatment from high risk but not referred to child protective services to children who were removed from parental care. METHOD: We employed a growth mixture modeling approach to model differential trajectories of children's emotion dysregulation from age four to age ten and assessed whether children's experiences of maltreatment prior to age four and caregiver histories of abuse were associated with children's probable class membership in the identified trajectories. RESULTS: We identified three classes of emotion dysregulation trajectories: Well-Regulated, Increasingly Dysregulated, and Highly Dysregulated. Early experiences of multiple maltreatment types and caregiver history of abuse were associated with higher odds that children would be in the Increasingly Dysregulated and Highly Dysregulated classes compared to the Well-Regulated class. CONCLUSION: The current study extends the literature on the negative associations of caregiver histories of abuse and child experiences of multiple maltreatment types to children's emotion dysregulation, which may be long-lasting. Furthermore, our findings highlight the need for intervening early as a crucial component of breaking the intergenerational impact of maltreatment.

Working toward Socially Responsive Recruitment Practices of Psychology Interns in an Academic Medical Center.

OBJECTIVE: This study describes a quality improvement (QI) process to reduce bias and increase inclusion and equity in the recruitment of health service psychology interns in an American Psychological Association-accredited psychology internship program at a national children's hospital. METHODS: This QI project utilized two Plan-Do-Study-Act (PDSA) cycles targeting the application review and the interview processes primarily using supervisor engagement and feedback to inform these processes. The goal of the PDSA cycles was to increase diversity in psychology doctoral interns offered interviews and ultimately recruited to the internship program. RESULTS: The application rating form was revised to place a greater emphasis on factors related to diversity, such as increasing the number of points applicants could earn for being bilingual. Regarding the interview process, structured interview questions were created, and a new, unified rubric was used to score interviewees. The changes in demographics of applicants selected for interviews and feedback from applicants who interviewed are reported. CONCLUSIONS: The QI process resulted in tangible changes to improve equitable and inclusive internship recruitment. Lessons learned throughout this process included the need for continual auditing of practices through an equity lens, engaging supervisors at all stages of the process, and implementing incremental actions.

Associations between dispositional parental emotion regulation and youth mental health symptoms: A systematic review and meta-analysis.

Theoretical perspectives propose that parents' dispositional emotion regulation (ER) tendencies are likely associated with youth mental health concerns. The aim of the current study was to conduct a systematic review and meta-analysis to evaluate the relationship between parental dispositional ER tendencies - both maladaptive and adaptive - and youth mental health symptoms. Regarding maladaptive parental ER, 32 unique studies (N = 6399) with 126 effects were included. A significant, small-to-moderate, effect was observed (r = 0.25) such that higher maladaptive parental ER was linked to heightened youth mental health symptoms. No differences were observed based on youth age or psychiatric risk status, yet effects were stronger when drawn from the same informant in contrast to different informants. Further, 12 studies (N = 4241) including 28 effects were identified and a significant, albeit small, relation (r = -0.16) between adaptive parental ER and youth mental health symptoms occurred. A narrative review of these studies evaluating adaptive parental ER and youth mental health symptoms was performed due to the limited number of effects found beyond parental dispositional mindfulness. These findings generally support the notion that parental dispositional ER tendencies are modestly associated with youth mental health concerns. Future directions and clinical implications are discussed.

Relationships between attention to emotion and anxiety among a community sample of adolescents.

BACKGROUND: Attentional bias to threat has been implicated as a cognitive mechanism in anxiety disorders for youth. Yet, prior studies documenting this bias have largely relied on a method with questionable reliability (i.e. dot-probe task) and small samples, few of which included adolescents. The current study sought to address such limitations by examining relations between anxiety - both clinically diagnosed and dimensionally rated - and attentional bias to threat. METHODS: The study included a community sample of adolescents and employed eye-tracking methodology intended to capture possible biases across the full range of both automatic (i.e. vigilance bias) and controlled attentional processes (i.e. avoidance bias, maintenance bias). We examined both dimensional anxiety (across the full sample; n = 215) and categorical anxiety in a subset case-control analysis (n = 100) as predictors of biases. RESULTS: Findings indicated that participants with an anxiety disorder oriented more slowly to angry faces than matched controls. Results did not suggest a greater likelihood of initial orienting to angry faces among our participants with anxiety disorders or those with higher dimensional ratings of anxiety. Greater anxiety severity was associated with greater dwell time to neutral faces. CONCLUSIONS: This is the largest study to date examining eye-tracking metrics of attention to threat among healthy and anxious youth. Findings did not support the notion that anxiety is characterized by heightened vigilance or avoidance/maintenance of attention to threat. All effects detected were extremely small. Links between attention to threat and anxiety among adolescents may be subtle and highly dependent on experimental task dimensions.

Maternal corticosteroids and depression during gestation and decreased fetal heart rate variability.

OBJECTIVE: Maternal depression during gestation is an adverse factor in fetal brain development that manifests in later childhood behavioral problems. Fetal heart rate variability (FHRV) mediated by parasympathetic input is a marker of gestational nervous system development. Biological mediators of adverse effects of maternal depression may involve the mother's corticosteroids; however, links between depression, corticosteroids, and early nervous system development remain inconclusive. METHODS: Heart rate was recorded in 23 fetuses by transabdominal Doppler at 28-33 weeks gestation. The SD of interbeat intervals over 20 min assessed FHRV. Maternal depression ratings and hair concentrations of cortisol and cortisone were assayed. An auditory sensory gating paradigm assessed newborn development of cerebral inhibition. Parents rated their infant's temperament characteristics on the Infant Behavior Questionnaire-Revised Short Form (IBQ-R). RESULTS: Maternal depression was associated with lower FHRV, especially for male fetuses, ß = -0.633, P = 0.045. Maternal depression was associated with lower cortisol to total corticosteroids ratios, ß = -0.519, P = 0.033. Lower cortisol ratios were associated with decreased FHRV, ß = 0.485, P = 0.019. Decreased FHRV was associated with increased newborn sensory gating deficits, ß = -0.992, P = 0.035, indicating poorer development of cerebral inhibition. Higher FHRV was related to increased infant IBQ-R self-regulatory behaviors, r = 0.454, P = 0.029. CONCLUSION: Maternal depression is associated via corticosteroids with decreased development of nervous system control of fetal heart rate. Decreased FHRV indicates developmental alterations in gestation that correlate with altered brain function and subsequent regulatory challenges in early infancy.

Perceived Executive Functioning in Parents at Risk for Child Physical Abuse.

Research suggests that deficits in executive functioning are associated with negative parenting behaviors. However, limited research has examined the link between executive functioning and risk for child physical abuse (CPA) perpetration. Early studies examining executive functioning in parents at risk for perpetrating CPA relied on performance-based measures, which are designed to occur under carefully controlled conditions and may not capture difficulties experienced under less optimal conditions (e.g., during chaotic caregiving situations). Moreover, prior studies examining executive functioning in parents at risk for perpetrating CPA have relied on small samples comprised of only mothers. To advance our understanding of the linkage between executive functioning and CPA risk, the present study examined perceived deficits in executive functioning in a sample of general population mothers and fathers (N = 98) using a standardized self-report measure of executive functioning, namely, the adult version of the Behavior Rating Inventory of Executive Function (BRIEF-A). Parents were classified as low CPA risk or high CPA risk using the Child Abuse Potential Inventory. Compared with low-risk parents, high-risk parents had higher rates of clinical elevations on several BRIEF-A subscales, namely, Working Memory Problems, Emotional Control Difficulties, and Difficulties Shifting Thoughts, Feelings, and Behaviors. These findings highlight the potential importance of assessing and strengthening executive functioning in interventions designed to reduce risk of parent-to-child aggression.

Development and Application of an Innovative Transdiagnostic Treatment Approach for Pediatric Irritability.

Recent work has drawn attention to the previously underrecognized role that irritability plays in childhood psychopathology. Despite increased recognition of the clinical importance of pediatric irritability as a transdiagnostic symptom dimension, there is a lack of evidence-based treatments for this population that simultaneously and equitably addresses both child and contextual (e.g., parental) factors implicated in the development and maintenance of associated emotional and behavioral difficulties. In the current pilot study, we adapted the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) for the treatment of pediatric irritability in a sample of 19 children (ages 8 to 12) with primary presenting concerns of irritability and/or disruptive behaviors. Results supported the feasibility and acceptability of this treatment and provided preliminary evidence that such an approach may yield improved outcomes for symptoms of pediatric irritability and disruptive behaviors. Implications of these findings for future research and clinical interventions for pediatric irritability are discussed.

Development and Initial Test of the Safety Behaviors in Test Anxiety Questionnaire: Superstitious Behavior, Reassurance Seeking, Test Anxiety, and Test Performance.

The purpose of the current studies is to identify safety behavior dimensions relevant to test anxiety, to develop a questionnaire to assess those dimensions, and to examine the validity of that questionnaire. Items were generated from interviews with college students ( N = 24). Another sample ( N = 301) completed an initial 33-item measure. Another sample ( N = 151) completed the final 19-item version the Safety Behaviors in Test Anxiety Questionnaire and provided access to their academic records. Interviews and expert evaluations were used to select items for the initial pool. An examination of item distributions and exploratory factor analysis were used to identify dimensions and reduce the item pool. Confirmatory factor analyses were used to validate the factorial structure. Correlational analyses were used to examine criterion validity of the final measure. The Safety Behaviors in Test Anxiety Questionnaire consists of a 9-item "Superstitious Behaviors" scale and a 10-item "Reassurance Seeking." The measure shows good content validity, factorial validity, internal consistency, and convergent and discriminant validity. Only the Reassurance Seeking scale showed good incremental criterion validity. Overall, these findings suggest that reassurance seeking may be a neglected target for interventions that might increase performance on high stakes tests.

Negative (but not Positive) Parenting Interacts with Infant Negative Affect to Predict Infant Approach: Evidence of Diathesis-Stress.

Temperament by parenting interactions may reflect that individuals with greater risk are more likely to experience negative outcomes in adverse contexts (diathesis-stress) or that these individuals are more susceptible to contextual influences in a 'for better or for worse' pattern (differential susceptibility). Although such interactions have been identified for a variety of child outcomes, prior research has not examined approach characteristics - excitement and approach toward pleasurable activities - in the first year of life. Therefore, the current study investigated whether 6-month maternal reported infant negative affect - a phenotypic marker of risk/susceptibility - interacted with 8-month observed parenting behaviors (positive parenting, negative parenting) to predict 12-month infant behavioral approach. Based a sample of mothers and their infants (N=150), results indicated that negative parenting was inversely associated with subsequent approach for infants with high, but not low, levels of early negative affect. Similar results did not occur regarding positive parenting. These findings better fit a diathesis-stress model rather than a differential susceptibility model. Implications and limitations of these findings are discussed.

Maternal Emotion Regulation Strategies, Internalizing Problems and Infant Negative Affect.

Recent work has identified links between mothers' self-regulation and emotion regulation (ER) and children's social-emotional outcomes. However, associations between maternal ER strategies (e.g., reappraisal, suppression), known to influence internalizing problems in adults, and children's negative affect (NA) have not been considered. In the current study, the direct and indirect relationships, through maternal internalizing problems, between maternal use of ER strategies and infant NA are examined. The potential effects of infant NA on maternal internalizing difficulties are also considered. Ninety-nine mothers and their infants participated across three time points during the first year postpartum. Higher maternal suppression was indirectly related to higher infant NA, through maternal internalizing problems; lower maternal reappraisal also was indirectly related to higher infant NA through maternal internalizing problems. Infant NA at four months postpartum was related to mothers' internalizing problems 6 months postpartum. The implications of these findings for future research and intervention are discussed.

High dose alcohol consumption predicts less reduction in post-traumatic stress symptoms after a campus mass shooting.

BACKGROUND: Recognizing that alcohol might affect subsequent processing of trauma-related information, this study examined whether high dose alcohol consumption (HDAC) following a campus mass shooting affected the relation between shooting exposure and post-traumatic stress symptoms (PTSS). METHODS: Female participants (N = 691) recorded levels of physical exposure to the shooting event, alcohol use, and PTSS 1 month following the shooting event and 8 months later. RESULTS: No evidence was found to suggest that pre-shooting HDAC moderated the relationship between trauma exposure and PTSS 1 month following the shooting. HDAC in the month following the shooting predicted less resolution of PTSS 8 months later. Specifically, at higher (but not lower) levels of HDAC, shooting exposure was associated with less reduction in PTSS from 1 to 8 months post-trauma. Several alternate explanations were ruled out. CONCLUSIONS: Less reduction in PTSS seems to occur at high levels of both shooting exposure and HDAC. Theoretical implications and directions for future research are discussed.

Heart rate variability indices as bio-markers of top-down self-regulatory mechanisms: A meta-analytic review.

Theoretical perspectives posit that heart-rate variability (HRV) reflects self-regulatory capacity and therefore can be employed as a bio-marker of top-down self-regulation (the ability to regulate behavioral, cognitive, and emotional processes). However, existing findings of relations between self-regulation and HRV indices are mixed. To clarify the nature of such relations, we conducted a meta-analysis of 123 studies (N=14,347) reporting relations between HRV indices and aspects of top-down self-regulation (e.g., executive functioning, emotion regulation, effortful control). A significant, albeit small, effect was observed (r=0.09) such that greater HRV was related to better top-down self-regulation. Differences in relations were negligible across aspects of self-regulation, self-regulation measurement methods, HRV computational techniques, at-risk compared with healthy samples, and the context of HRV measurement. Stronger relations were observed in older relative to younger samples and in published compared to unpublished studies. These findings generally support the notion that HRV indices can tentatively be employed as bio-markers of top-down self-regulation. Conceptual and theoretical implications, and critical gaps in current knowledge to be addressed by future work, are discussed.

Social Anxiety and Relationship Formation During the College Transition: Self-Verification, Self-Image, and Victimization.

This study tested a self-verification model of social anxiety in the context of relationship formation during the transition to college. Incoming college freshmen (N = 68) completed measures of social anxiety and social self-esteem at the beginning of college and 10 weeks later. Using sociometric ratings completed 10 weeks later, relational victimization appeared to be a unitary construct and not distinct from physical victimization. Participants with low social self-esteem at Time 1 were subsequently seen as victimized, reported disliking spending time at Time 2 with peers who reported liking them, and reported high social anxiety at Time 2 even in the absence of subsequent victimization. The implications of these results for understanding the role of self-verification processes in the maintenance of self-image and social anxiety are discussed.

Focus-of-attention behavioral experiment: an examination of a therapeutic procedure to reduce social anxiety.

A clinical protocol based on contemporary cognitive behavioral treatment for social anxiety was developed and examined. Previously published instructions for conducting a focus-of-attention behavioral experiment targeting self-focused attention and safety behaviors during exposure were used to create a structured protocol. Individuals (n = 45) with high levels of social anxiety and public-speaking anxiety were randomly assigned to either a focus-of-attention behavioral experiment (FABE) or an Exposure-Only Control (EOC) condition. During four exposure trials, those in the FABE condition (n = 24) were alternately instructed to engage in self-focused attention vs. externally focused attention and to eliminate safety behaviors. Those in the EOC condition (n = 21) were not so instructed. At post-intervention, individuals in the FABE condition showed significantly less self-focused attention and anxiety, and better observed performance as rated by audience members. Focus-of-attention statistically mediated the effect of condition on anxiety. For those in the FABE condition, the degree of association between focus-of-attention and anxiety during the intervention predicted less self-focused attention post-intervention. The FABE appears to be a useful procedure for implementing part of the contemporary cognitive behavioral treatment model.

Self-focused attention affects subsequent processing of positive (but not negative) performance appraisals.

BACKGROUND AND OBJECTIVES: Cognitive-behavioral models highlight the conjoint roles of self-focused attention (SFA), post-event processing (PEP), and performance appraisals in the maintenance of social anxiety. SFA, PEP, and biased performance appraisals are related to social anxiety; however, limited research has examined how SFA affects information-processing following social events. The current study examined whether SFA affects the relationships between performance appraisals and PEP following a social event.. METHODS: 137 participants with high (n = 72) or low (n = 65) social anxiety were randomly assigned to conditions of high SFA or low SFA while engaging in a standardized social performance. Subsequent performance appraisals and PEP were measured. RESULTS: Immediate performance appraisals were not affected by SFA. High levels of SFA led to a stronger, inverse relationship between immediate positive performance appraisals and subsequent negative PEP. High levels of SFA also led to a stronger, inverse relationship between negative PEP and changes in positive performance appraisals.. LIMITATIONS: Future research should examine whether the current findings, which involved a standardized social performance event, extend to interaction events as well as in a clinical sample. CONCLUSIONS: These findings suggest that SFA affects the processing of positive information following a social performance event. SFA is particularly important for understanding how negative PEP undermines positive performance appraisals..

The Combination of Health Anxiety and Somatic Symptoms: Examining Associations With Health-Related Beliefs and Gender Differences.

Current diagnostic criteria suggest that some individuals experience health anxiety and severe somatic symptoms, whereas others experience health anxiety and either no or mild somatic symptoms. However, to date, our understanding of potential differences among individuals with health anxiety and varying severity of somatic symptoms remains limited. Adopting a dimensional approach, we completed this study to help fill this gap in the literature by examining whether the interactive effect between health anxiety and somatic symptoms was related to health-related beliefs among men (n = 211) and women (n = 220). Among both men and women, health anxiety was related to certain health-related beliefs, particularly anxiety sensitivity, only when coupled with severe somatic symptoms. Conceptual and therapeutic implications of these results are discussed.

Self-Focused Attention and Post-Event Processing: Relevance to Social Performance Anxiety and Social Interaction Anxiety.

This study examined the roles of self-focused attention and post-event processing in social performance anxiety and social interaction anxiety. College students (N = 101) completed measures of social performance anxiety, social interaction anxiety, self-focused attention, post-event processing, and beliefs related to social anxiety. Interoceptive self-focused attention and post-event processing predicted social performance anxiety after controlling for social interaction anxiety. The associations with social interaction anxiety were not significant after controlling for social performance anxiety. Associations of behavioral self-focused attention with social performance anxiety and social interaction anxiety were not significant after controlling for interoceptive self-focused attention. No evidence of an interaction between self-focused attention and post-event processing in the prediction of social anxiety was found. This study found no evidence that the associations of interoceptive self-focused attention and post-event processing with social performance anxiety were statistically mediated by high standards, conditional beliefs about self, and unconditional beliefs about self. These results and their theoretical implications are discussed.