The association between maternal and child posttraumatic stress symptoms among families living in southern Israel: The buffering role of maternal executive functions.

Posttraumatic stress disorder is a prolonged stress and anxiety response that occurs after exposure to a traumatic event. Research shows that both parental and child posttraumatic stress symptoms (PTSS) are correlated but parental executive functions (EFs) could buffer this link. EFs refers to a group of high-level cognitive processes that enable self-regulation of thoughts and actions to achieve goal-directed behaviours and can be of importance for both positive parenting interactions and effective coping skills for PTSS. Our study aimed to (1) examine the link between maternal and child PTSS and the moderating role of varying degrees of exposure to severe security threats context, and (2) to identify the moderating role of maternal EFs in this interaction, among families living in southern Israel. Our sample included 131 mothers in their second pregnancy and their firstborn children. Mothers performed computerised tasks to assess their EFs and they reported on their own and their child's PTSS. Results revealed a positive correlation between maternal PTSS and child PTSS. However, the link between maternal and child PTSS was moderated by maternal working memory updating abilities and threat context severity. Among mothers with lower updating capacities, the association between maternal and child symptoms was stronger under higher threat contexts; conversely, among mothers with higher maternal updating abilities, threat context did not modulate the link between maternal and child PTSS, suggesting a stress-buffering effect. Our study contributes to the growing literature on the significant role of parental EFs in the context of parent-child interactions.

Maternal Perceptions and Responsiveness to Cry in Armed Conflict Zones: Links to Child Behavior Problems.

Crying is a typical infant behavior that activates parental caregiving behaviors, acting as "human alarms" important for the infant's survival. When living under war-related threat, the auditory system may be sensitized given its importance for survival, potentially impacting maternal cry processing. Children living in armed-conflict zones are at increased risk for behavior problems, which may relate to both direct exposure and indirect effects through their parents' perceptions and behaviors. This hypothesis was examined in a sample of mothers and their first-born children (aged 10-45 months) living in the Gaza vicinity area in Israel, chronically exposed to missile alarms (high-exposure; n = 45), and a comparison group (low-exposure; n = 86). Group differences in child behavior problems and maternal perceptions of and responsiveness to cry were investigated. A moderated indirect-effect of maternal cry perceptions on child behavior problems via maternal responsiveness to cry was examined. In the high-exposure group, children had more externalizing problems and mothers rated cries as more aversive. Maternal cry perception was indirectly related to child behavior problems via responsiveness to cry only in the high-exposure group: higher perceptions of cry as aversive or the child as distressed were related to faster responding to crying, and faster cry responsiveness was linked with fewer behavior problems. Results suggest that in armed-conflict zones with auditory warning signals, the parental caring system may be easily activated by cries due to the strong association between alarms and threat. Furthermore, children may need their mothers to react faster when feeling distressed, possibly because of the surrounding threat.

What works for whom? Moderators in parental reflective functioning intervention.

The DUET program (a group intervention) aims to enhance parental reflective functioning (PRF). We examined whether pretreatment levels of key outcomes as well as individual parental and family-environment characteristics predicted improvement after intervention with the DUET program. One hundred forty-two parents (native Israelis; mean age = 34.84 years) of preschool children (n = 107; mean child age = 4.3 years; 53% female) were assessed before, after, and 6 months following the intervention. Results indicated significant associations between lower levels of key outcomes at the pretreatment assessment and greater improvement after treatment in PRF, child self-regulation, and child self-distraction strategies. Furthermore, two subgroups of families were uncovered based on individual parental and family-environment characteristics: low-distress and high-distress parents. Following intervention, the high-distress group showed greater improvement in parental sensitivity and child problem behavior, whereas the low-distress group reported greater improvement in locus of control. Clinical and future directions are discussed.

Parental guilt and children's internalizing and externalizing behavior: The moderating role of parental reflective functioning.

The immense responsibility inherent in parenthood makes feeling guilty highly prevalent among parents. Such feelings are natural, yet excessive guilt is related to depression and anxiety and could burden parents. Qualitative research suggested that guilt is predominant in parents whose children suffer from behavioral and emotional difficulties, making it necessary to quantify guilt and examine possible resilience factors that could alleviate the aversive aspects of it. In this study, we examined the association between children's externalizing and internalizing problems and different aspects of parental guilt, assessing whether parental reflective functioning (PRF) would moderate these associations. One hundred six parents of children aged 1.30-9.30 years were recruited from child daycare centers and community clinics. The Parent Development Interview was administered to measure PRF. Based on this interview, we created a new coding system, to quantify three aspects of parental guilt: intensity, reparation, and internal reaction to guilt. Children's difficulties as well as parents' depression and anxiety were assessed using validated self-report measures. We showed that children's difficulties were related to parental guilt, but only when levels of PRF were not high. Specifically, internalizing problems were related to greater intensity and negative internal reaction to guilt only when PRF was low or moderate, and externalizing problems were related to greater intensity of guilt only when PRF levels were low. These findings suggest that encouraging reflective functioning could reduce the burden of guilt. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The predictors of change in reflective parenting therapy: Uncovering the influence of parental reflective functioning and child temperament in predicting the improvement in parent-child relationship and child outcome following DUET group intervention.

Parental reflective functioning (PRF) is the ability of parents to understand their child's behavior in light of underlying mental processes; it is a core element in the parent-child relationship. RF is also considered crucial for self-regulation for both parents and their children. We investigated the relationship between improvement in PRF after DUET group intervention (a RF-based intervention) and improvement in the parent-child interaction, child RF, and child adjustment, and we examined whether these improvements were distinct for children with different temperamental traits (e.g., effortful control). Eighty-four parents completed the DUET program and were assessed before and after the intervention. PRF was measured using observation (mind-mindedness) and a questionnaire. Statistical analysis included hierarchical regression and moderation of regression analysis. Results showed that improvement in the parent-child interaction, child RF, and child behavioral problems were related to improvement in PRF. Furthermore, we found that child temperament acted as a moderator in the link between PRF and child RF, supporting a vantage sensitivity model, meaning that it was the more sensitive children who benefitted the most as a result of the positive change in their parents' RF. Clinical and future directions of this study are discussed.

Home-quarantine during the initial Covid-19 outbreak in Israel: parent perceived impact on children with ASD.

Background: Studies have reported that Covid-19 home-quarantine periods have had mostly negative psychological impact on children with ASD and their families. Here we examined parent perceived impact of a 6-week quarantine period imposed in Israel at the beginning of the Covid-19 outbreak, in mid-March 2020. Methods: An anonymous online questionnaire was completed by parents of 268 children with ASD. Parents rated deterioration/improvement in their child's behaviors, abilities, mood, sleep, and anxiety along with changes in their own mood, sleep, parenting skills, and family relationships. We performed t-tests and ANOVA analyses to assess the significance of perceived impact on each domain and potential differences in the impact across families with children of different ages, genders, and levels of required support as well as families that experienced different magnitudes of economic hardships. Results: Parents reported significant deterioration in their mood and sleep along with significant improvements in relationships with their spouse and child with ASD, and in their parenting skills. Parents also reported significant increases in the severity of tantrums, anxiety, and restricted and repetitive behavior symptoms along with significant improvements in social and communication abilities of their child with ASD. Ratings were significantly lower in families of ASD children who regularly require more support and in families that experienced economic hardships. Conclusions: While periods of home-quarantine create numerous hardships for families of children with ASD, they may also offer an opportunity for improving parenting skills, family relationships, and children's social communication abilities with potential relevance for improving remote services.

When COVID-19 Met Families Living in Armed-Conflict Zones: The Importance of Maternal Trauma and Child Self-Regulation.

The COVID-19 outbreak began in Israel at the end of February 2020, and on March 17, 2020, a general lockdown was announced. Families were instructed to stay at home and schools and non-essential businesses were closed. Aiming to understand how families who were already living in areas of high exposure to armed conflict would be affected by another external stressful condition, data were collected before and after the outbreak. Mothers and children (aged 10-45 months) were recruited from areas with high (n = 40) and low (n = 78) exposure to armed conflict. Mothers reported on their posttraumatic stress symptoms (PTSS) and on their child's effortful control tendencies prior to the outbreak. Toward the end of the first lockdown, mothers were interviewed regarding adverse effects of the outbreak on their family. No group differences were found for maternal perceptions of adverse effects of COVID-19. However, a moderation model was revealed, indicating that maternal PTSS as well as child effortful control predicted adverse effects of COVID-19 only in the high-exposure group. Results are discussed considering cumulative stress and risk factors.

Maternal Postpartum Emotional Distress and Preterm Social Withdrawal in the Bedouin Culture.

This study aimed to test a serial mediation model proposing that prematurity would be related to changes in maternal emotional distress, which in turn would be related to the mother-child (M-C) interaction, which would ultimately be related to infant social withdrawal. Bedouin mothers and their preterm (n = 48) and full-term (n = 57) infants participated in this study. Mothers' mean age was 27.67 years. In addition, 39.4% of the mothers were primiparas and 60.6% were multiparas. Infants and their mothers were recruited shortly after birth (T1) in the maternity ward or Neonatal Intensive Care Unit (NICU) at Soroka Medical Center and were followed up at ages 6 months (T2) and 12 months (T3). Findings indicated that HIGHER levels of maternal emotional distress during the second half of the first year postpartum and LOWER levels of mother-child interaction, were associated with HIGHER levels of infant social withdrawal at T3. Furthermore, the overall indirect effect suggested that HIGHER levels of maternal nonhostility was a main variable mediating the link between prematurity and LOW levels of infant social withdrawal. Our findings provide evidence that changes in maternal emotional distress during the first year are related to lower infant social withdrawal. Moreover, mothers of premature infants showed higher levels of nonhostility when interacting with their premature infants. These findings highlight the importance of gaining a better understanding of maternal behaviors. Specifically, our study provides important information for researchers and clinicians on a possible mechanism leading to early socioemotional difficulties of premature infants.

The potential moderating role of living in a conflict area on the link between classroom psychosocial stressors, perceived stress and change in anxiety symptoms in Israeli school children.

Background: Perceived stress associated with relational victimization from peers and conflictual relations with the teacher have been linked with the development of anxiety symptoms in children. Living in conditions of ongoing stress from the broader environment has also been related to anxiety symptoms in children. In this study, we examined (a) the indirect effect between classroom psychosocial stressors (i.e., relational victimization and conflictual relationships with teachers), perceived stress and anxiety symptom development, and (b) whether this indirect effect was stronger for children living in a high threat region than for children living in a lower threat region. Methods: Children participating in the study attended elementary school either in a high threat of armed conflict region (15 s to hide in bomb shelter when alarm sounds, n = 220) or in a lower threat of armed conflict region (60 s to hide in a bomb shelter when alarm sounds, n = 188) in Israel. Children were first assessed on conflictual relationships with teachers and peers, subjectively perceived stress and anxiety in 2017 (T 0; M age = 10.61 years, SD = 0.78; 45% boys) and re-assessed (T 1) 1 year later, in 2018. Results: Perceived stress mediated the association between classroom psychosocial stressors and anxiety development. No moderation by threat-region was found in this indirect effect. However, the association between perceived stress and anxiety development was only significant for children in the high threat region. Conclusion: Our study suggests that threat of war conflict amplifies the association between perceived stress and the development of anxiety symptoms.

Improving the parent-child relationship and child adjustment through parental reflective functioning group intervention.

Parental reflective functioning (PRF) is a core element in the parent-child relationship. This study set out to investigate changes in PRF following the DUET program, a 12-week group intervention program. We proposed that the DUET intervention would enhance maternal reflective capacities, resulting in better mother-child emotional availability, better child self-regulation, and decreased child behavioral problems. Seventy mothers completed the DUET group intervention. Of these mothers, nine mothers were first allocated to the waiting-list group and thereafter were included in an intervention group. PRF was measured using observation (mind-mindedness) and an interview (PDI). Following the intervention, a significant improvement was evident in PRF, in parental beliefs about feeling, and in parental sense of efficacy. In addition, the mother-child interaction was more positive, child behavioral problems decreased, and child self-regulation increased. This improvement remained stable over a period of 6 months. Clinical and future directions of this study are discussed.

Prematurity, maternal emotional distress, and infant social responsiveness among Arab-Bedouin families: The role of social support as a resilience factor.

This study investigated predictors of early infant social development and the role of social support as a resilience factor among Arab-Bedouin families. We propose a mediation model in which social support will be related to maternal postpartum emotional distress (PPED), which in turn will be related to infant social responsiveness. One hundred five Arab-Bedouin mothers (age range = 17-44 years) and their preterm (n = 48) and full-term (n = 57) infants were recruited shortly after birth and were followed up at age 12 months. Findings demonstrate that, among the preterm group, higher levels of social support predicted lower levels of maternal PPED, and this, in turn, predicted higher levels of infant social responsiveness.

Sleep, screen time and behaviour problems in preschool children: an actigraphy study.

Inadequate sleep and excessive exposure to media screens have both been linked to poorer mental health in youth. However, the ways in which these interact to predict behaviour problems have yet to be examined using objective sleep measurement. The lack of objective evidence for these relationships in young children has recently been defined by the World Health Organization (2019) as a gap in the field. We thus aimed to test the interacting effects of screen exposure and objectively measured sleep on behaviour problems in the preschool age. A total of 145 children aged 3-to-6-years participated in this cross-sectional study. Sleep was assessed objectively using actigraphy for 1-week, and subjectively using parent-reported daily sleep diaries. Parents reported the child's daily duration of screen exposure, and completed the Strengths and Difficulties Questionnaire. Results showed that actigraphic sleep duration, timing and efficiency were associated with screen exposure. The link between screen time and behaviour problems was moderated by sleep duration, as it was significant only for children with sleep duration of 9.88 h or less per night. Sleep duration also moderated the relation between screen time and externalizing-but not internalizing-problems. Hence, the combination of increased screen exposure and decreased sleep duration may be particularly adverse for child mental health. While these key relationships should be further examined in longitudinal and experimental investigations, our findings shed light on their complexity, underscoring the importance of the moderating role of sleep.

The role of parental playfulness as a moderator reducing child behavioural problems among children with intellectual disability in Israel.

BACKGROUND: Playfulness is well known to be vital for child development. However, not much is known regarding parental playfulness. We set out to investigate the role of parental playfulness in children with intellectual disabilities (ID) and typical development (TD) living in Israel. Specifically, we examined 1) differences in parental playfulness between groups and 2) parental playfulness as a moderator in the link between developmental status and behavioural problems (BP). METHOD: One hundred forty-two families living in Israel and their children (48 % with ID) aged 4-7 years participated in the study. Parent-child play interaction was videotaped and coded for parental playfulness. Parents reported on child BP using the CBCL questionnaire. RESULTS: Parents in the ID group showed lower levels of playfulness compared to parents in the TD group. Father's playfulness acted as a moderator in the link between developmental status and child BP. CONCLUSIONS: These results highlight the unique role of father's playfulness in the developmental status of a child diagnosed with ID.

Prematurity and Maladaptive Mealtime Dynamics: the Roles of Maternal Emotional Distress, Eating-Related Cognitions, and Mind-Mindedness.

Premature birth and maternal emotional distress constitute risk factors for feeding disorders. This study examined the roles of maternal cognitions in the link between prematurity, emotional distress and mother-infant maladaptive mealtime dynamics in a sample of 134 families (70 preterm, low medical risk; 64 full-term) followed longitudinally. Specifically, maternal cognitions related to eating and health (perception of child vulnerability and concerns about child's eating) and understanding of mental states (interactional mind-mindedness) were considered. A multiple-mediators model was tested, controlling for infants' weight and breastfeeding history. Although prematurity did not directly predict mealtime dynamics, multiple-mediation analyses revealed indirect pathways: mothers of preterm newborns reported higher emotional distress, which subsequently predicted perception of child vulnerability and concerns about child's eating at 6-months; perception of child vulnerability predicted more conflictual mealtime dynamics, whereas concern about child's eating predicted less reciprocal mealtime dynamics at 12-months. Mind-mindedness at 6-months predicted more reciprocal and less conflictual mealtime dynamics but did not act as a mediator. Implications for understanding pathways from prematurity to feeding disorders are discussed.

When do mothers' executive functions contribute to their representations of their child's mind? A contextual view on parental reflective functioning and mind-mindedness.

Parental mentalization refers to parents' capacity to treat their children as having minds of their own and consider the mental states underlying their behaviors. This study examined the roles of mothers' executive functions (EFs), a group of processes supporting self-regulation, in 2 aspects of parental mentalization-spontaneity as measured by mind-mindedness (MM), and complexity as measured by parental reflective functioning (PRF)-while examining child- and family related contextual-moderators. Ninety-nine mothers of 66-month-old preschool children (40 full-term, 59 preterm) completed EFs tasks, were interviewed regarding their child and coparenting, and rated their perception of their child as being difficult (i.e., difficult behavior and negative emotionality). EFs were unrelated to MM. However, EFs were related to PRF when children were rated as more difficult, and when mothers reported high coparenting dissatisfaction; moreover, EFs and PRF were associated among mothers of full-term children, but not in the preterm group. Findings indicate that EFs contribute to the complexity and coherence of maternal mentalization, especially in contexts in which regulation is required for being able to consider the child's mind (difficult child, coparenting dissatisfaction), but not in stressful contexts that are likely to elicit automaticity (prematurity). EFs, however, do not seem to contribute to spontaneous attribution of mental states to the child, when complexity is not considered. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A mediation model of parental stress, parenting, and risk factors in families having children with mild intellectual disability.

In accordance with the determinant of parenting model (Belsky, 1984), a conceptual model is proposed in which parental stress mediates the links between child, proximal, and distal risk factors and parental behavior. Participants were 156 families with children aged 4-7 years (M = 5.64 years, SD = 0.62; 59 % boys); research group: 75 two-parent families having children with mild intellectual disability (MID); control group: 81 two-parent families with typically developed (TD) children. Parents completed questionnaires, and parent-child interactions were videotaped. Results indicated differences between groups in levels of parental stress and child and proximal risk factors, but not in distal risk factors. Furthermore, the paths between the proximal and child levels of risk to maternal parenting were mediated by maternal stress for both MID and TD groups. Risk factors were linked to paternal stress for all fathers, yet the mediation effect was only found for families with TD children. Distal risk factors significantly influenced maternal and paternal parenting, but only in families having children with MID and with no mediation of stress. The importance of being mindful to both proximal and distal ecologies of children with MID and their parents is discussed, as is the need to address the different influences fathers and mothers may have on their children.

Neonatal Risk, Maternal Sensitive-Responsiveness and Infants' Joint Attention: Moderation by Stressful Contexts.

Neonatal risk factors have been associated with atypical development in various areas of social communication, including joint attention (JA), but little is known about factors in the early caregiving environment that can modify the negative implications of neonatal risk. The present study examines the links between neonatal risk and infants' JA, while considering the mediating role of maternal sensitive-responsiveness and the moderating roles of stressful contexts. One hundred and eighty-two families with infants (50% female) born in a wide range of gestational ages and birthweights participated in the study. Neonatal risk was assessed shortly after birth using three indicators: birthweight, gestational age, and degree of medical risk. At age 6 months, maternal sensitive-responsiveness to infants' foci of attention was rated and maternal anxiety and household chaos were measured. Infants' JA behaviors were assessed at age 12 months. A moderated-mediation model revealed that maternal anxiety symptoms and household chaos moderated the links between neonatal risk, maternal sensitive-responsiveness, and infants' responding to JA. Specifically, neonatal risk was related to less maternal sensitive-responsiveness only when maternal anxiety symptoms were above average levels, but not when anxiety symptoms were low. Moreover, maternal sensitive-responsiveness was positively related to infants' responding to JA behaviors when household chaos was low but not when it was high. These findings highlight the complex nature of the links between infants' early biological risk and caregiving environments in the development of social communication skills.

What's going on in my baby's mind? Mothers' executive functions contribute to individual differences in maternal mentalization during mother-infant interactions.

Maternal mentalization refers to a mother's capacity to understand mental-states of herself and her child and to regard her child as a psychological agent. In mother-infant interactions, this capacity is commonly conceptualized as maternal mind-mindedness, which can be divided into two dimensions: appropriate and nonattuned interpretations of the infants' mental-states. Appropriate mind-mindedness refers to interpretations that seem to be compatible with the infant's behaviors, whereas nonattuned mind-mindedness refers to noncompatible interpretations. The aim of this study was to investigate the cognitive mechanisms that contribute to mind-mindedness. Specifically, we investigated the role of executive functions in appropriate and nonattuned mind-mindedness, and the moderating roles of two infant-related factors, prematurity (as a stressful context) and child temperament (as a context of unpredictability and negative emotionality). To this end, mother-infant free play interactions were coded for mind-mindedness in a sample of 102 mothers and their 6-month-old infants (61 preterm, 41 full-term). When children were 66-months old, mothers completed cognitive tasks that assessed working memory updating, resistance to interference, response inhibition, and shifting. Appropriate mind-mindedness was positively associated with updating, and this link was stronger when infant temperament was rated as more difficult. Furthermore, among mothers of full-term infants, mothers' resistance to interference was negatively associated with nonattuned mind-mindedness. This link was not evident in the stressful context of premature birth. Mothers' response inhibition and shifting were not associated with either of the mind-mindedness dimensions. Implications on understanding variability in maternal mentalization during mother-infant interactions and the roles of executive functions in parenting are discussed.

Predicting ADHD Symptoms in Adolescence from Early Childhood Temperament Traits.

Extreme levels of certain temperament traits can be early markers of different developmental pathways of attention-deficit/hyperactivity disorder (ADHD). However, the long-term utility of using these traits as predictors of ADHD is not fully known. This study includes 64 male adolescents (M age = 13.5), who have been followed since birth as part of a longitudinal study. The primary aim was to test effortful control (EC), activity level, and anger, measured in early childhood - both with mother's reports and laboratory assessments -as predictors of ADHD symptoms in adolescence. Further, we investigated the specificity of this prediction to the different ADHD symptom domains. The results demonstrated that early temperament dimensions of EC and activity level were predictive of ADHD symptoms about 10 years later, when the participants reached adolescence. Moreover, activity level showed specificity only to hyperactivity-impulsivity symptoms whereas EC was a predictor of the two symptom domains. Anger had a predictive correlation with ADHD symptoms; however, it did not have a unique predictive contribution. These results emphasize the relevance of EC and activity level in the developmental course of ADHD. Identification of early risk factors can lead to more efficient design and implementation of intervention programs.

MOTHER-CHILD AND FATHER-CHILD PLAY INTERACTION: THE IMPORTANCE OF PARENTAL PLAYFULNESS AS A MODERATOR OF THE LINKS BETWEEN PARENTAL BEHAVIOR AND CHILD NEGATIVITY.

Based on the premise that father-child play is an important context for children's development and that fathers "specialize" in play, similarities and differences in the role of playfulness in the father-child and mother-child relationship were examined. Participants in this study included 111 families (children's age: 1-3 years). Father-child and mother-child play interactions were videotaped and coded for parental playfulness, sensitivity, structuring, and nonintrusiveness as well as child negativity. Results indicated that mothers and fathers did not differ in playfulness and that mothers and fathers who were higher in playfulness had children with lower levels of negativity. However, playfulness differently moderated the links between parents' and children's behaviors for mothers and fathers. A double-risk pattern was found for mothers, such that the links between child negativity and maternal sensitivity, structuring, and nonintrusiveness were significant only for the subgroup of mothers with low levels of playfulness. When mothers had high levels of playfulness, these effects were negligible. For fathers, a double-buffer pattern was revealed, indicating that the links between child negativity and paternal sensitivity and structuring were significant only for fathers with high levels of playfulness. When fathers had low levels of playfulness, these effects were negligible. These findings demonstrate the important role that parental playfulness has on parent-child interaction as well as the need to examine moderation patterns separately for fathers and mothers.