Research Review: Child emotion regulation mediates the association between family factors and internalizing symptoms in children and adolescents - a meta-analysis.

BACKGROUND: Parental influence on children's internalizing symptoms has been well established; however, little is known about the underlying mechanisms. One possible mechanism is child emotion regulation given evidence (a) of its associations with internalizing symptoms and (b) that the development of emotion regulation during childhood and adolescence is influenced by aspects of the family environment. This meta-analysis aimed to systematically investigate the mediating role of child emotion regulation in the relationship between various family factors and internalizing symptoms in children and adolescents. METHODS: We searched Medline, Embase, PsychInfo, and Web of Science for English articles up until November 2022. We included studies that examined child emotion regulation as a mediator between a family factor and child/adolescent internalizing symptoms. Random-effects models were used to calculate pooled indirect effects and total effects for nine family factors. Heterogeneity and mediation ratio were also calculated. RESULTS: Of 49 studies with 24,524 participants in this meta-analysis, family factors for which emotion regulation mediated the association with child/adolescent internalizing symptoms included: unsupportive emotion socialization, psychological control, secure attachment, aversiveness, family conflict, parent emotion regulation and parent psychopathology, but not supportive emotion socialization and behavioral control. CONCLUSIONS: Various family factors impact children's emotion regulation development, and in turn, contribute to the risk of internalizing symptoms in young people. Findings from this study highlight the need for interventions targeting modifiable parenting behaviors to promote healthy emotion regulation and better mental health in children and adolescents.

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

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

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

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

A Preliminary Evaluation of the Cultural Appropriateness of the Tuning in to Kids Parenting Program in Germany, Turkey, Iran and China.

Background: Parenting interventions based on emotion socialization (ES) theory offer an important theoretically driven approach to improve children's emotional competence and behavioral functioning. Whether such approaches are effective in different cultural contexts, and whether the methods of delivery used are appropriate and acceptable, is an important empirical question. This paper reports on the preliminary evaluation of an ES parenting intervention, Tuning in to Kids (TIK), in Germany, Turkey, Iran, and China. Pilot studies of TIK have been conducted in each country with mothers of 4-6-year-old children. Method: The current study used qualitative methods with thematic analysis to explore the cultural appropriateness of the program in each site. Results: Culture-specific challenges were found across all sites in changing parents' beliefs about the value of encouraging children's emotional expression and supportive emotion discussions. Emotion literacy of parents depended on their access to emotion terms in their language, but also to parents' experiences with emotions in their family of origin and culture-related beliefs about emotions. Adaptations were required to slow the speed of delivery, to address issues of trust with parents in seeking help, and to provide more opportunities to practice the skills and integrate different beliefs about parenting. Conclusion: While this ES parenting intervention has been developed in a Western cultural context, slight adaptations to the delivery methods (rather than change to the content) appeared to contribute to cultural appropriateness. The next step will be to quantitatively evaluate these adaptations of TIK in the different countries using randomized controlled studies.

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

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

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

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

Trauma-Focused Tuning in to Kids: Evaluation in a Clinical Service.

This study evaluated the Tuning in to Kids (TIK) parenting program delivered in a clinical setting with 77 parents and caregivers (hereafter referred to as "parents") of children who had experienced complex trauma. The TIK program targets parent emotion socialization to improve children's emotional and behavioral functioning. The study utilized a single-group design with pre- and post-intervention measures. Seventy-seven parents of children (aged 3-15 years) who had experienced complex trauma completed a ten-week version of the Trauma-Focused Tuning in to Kids program (TF-TIK). Measures examined parent reports of: emotion socialization; parent-child relationship; parent mental health; children's emotional and behavioral functioning. Parents reported significantly improved emotion socialization, parent-child relationship, parent mental health, as well as child emotion regulation and behavior. This study provides initial support for the use of the TF-TIK parenting program in a clinical setting with parents of children who have experienced complex trauma in order to prevent or reduce problems.

The Child and Parent Emotion Study: protocol for a longitudinal study of parent emotion socialisation and child socioemotional development.

INTRODUCTION: Parents shape child emotional competence and mental health via their beliefs about children's emotions, emotion-related parenting, the emotional climate of the family and by modelling emotion regulation skills. However, much of the research evidence to date has been based on small samples with mothers of primary school-aged children. Further research is needed to elucidate the direction and timing of associations for mothers and fathers/partners across different stages of child development. The Child and Parent Emotion Study (CAPES) aims to examine longitudinal associations between parent emotion socialisation, child emotion regulation and socioemotional adjustment at four time points from pregnancy to age 12 years. CAPES will investigate the moderating role of parent gender, child temperament and gender, and family background. METHODS AND ANALYSIS: CAPES recruited 2063 current parents from six English-speaking countries of a child 0-9 years and 273 prospective parents (ie, women/their partners pregnant with their first child) in 2018-2019. Participants will complete a 20-30 min online survey at four time points 12 months apart, to be completed in December 2022. Measures include validated parent-report tools assessing parent emotion socialisation (ie, parent beliefs, the family emotional climate, supportive parenting and parent emotion regulation) and age-sensitive measures of child outcomes (ie, emotion regulation and socioemotional adjustment). Analyses will use mixed-effects regression to simultaneously assess associations over three time-point transitions (ie, T1 to T2; T2 to T3; T3 to T4), with exposure variables lagged to estimate how past factors predict outcomes 12 months later. ETHICS AND DISSEMINATION: Ethics approval was granted by the Deakin University Human Research Ethics Committee and the Deakin University Faculty of Health Human Research Ethics Committee. We will disseminate results through conferences and open access publications. We will invite parent end users to co-develop our dissemination strategy, and discuss the interpretation of key findings prior to publication. TRIAL REGISTERATION: Protocol pre-registration: DOI 10.17605/OSF.IO/NGWUY.

Emotion-focused parenting interventions for prevention and treatment of child and adolescent mental health problems: a review of recent literature.

PURPOSE OF REVIEW: To review recent studies on emotion-focused parenting interventions to provide clinicians with knowledge about how these approaches might be used in prevention and treatment of mental health difficulties for children, adolescents and their families. RECENT FINDINGS: A number of emotion-focused parent interventions are reported in the literature, including emotion coaching/communication parenting programs, emotion-focused family therapy, attachment-focused parenting interventions (including those that address parental reflective functioning/mentalization), mindfulness parenting programs and behavioral programs with added emotion components. All target emotions or emotional communication to assist parents and children understand and work through emotional experiences so they are less likely to impede healthy functioning. These interventions target four main domains: exploring family of origin or early attachment/relational experiences with emotion, targeting parents' own emotion awareness and regulation, shifting parents responses to or communication with their children when emotions occur, and promoting parents' skills for assisting children to regulate emotions and behavior. This review from the last 18 months found 50 studies that evaluated programs addressing these domains. SUMMARY: Whilst the dominant approach in evidence-based parenting programs has been teaching behavioral strategies, it has been recognized that a focus on emotion-related processes is important. This is especially when working to improve the attachment relationship or when parents and children experience emotion dysregulation. This review demonstrates extensive evidence to support emotion-focused parenting interventions.

Tuning in to Teens: Investigating moderators of program effects and mechanisms of change of an emotion focused group parenting program.

In recent years emotion socialization theory (Eisenberg, Cumberland, & Spinrad, 1998) has begun to be used in parenting interventions, allowing an important and effective method for testing the theory. The current study is one such example, and examined moderators of program effects and mechanisms of change in an emotion-focused group parenting program, Tuning in to Teens (TINT), to determine whether an intervention with this theoretical approach would be effective in improving adolescent internalizing difficulties. Schools were randomized into intervention and control conditions. Data was collected from 225 parents and 224 youth during the young person's final year of elementary school (6th grade) and again, 10 months later in their first year of secondary school (7th grade). Those in the intervention condition received a 6-session program targeting parent emotion awareness/regulation, parental beliefs about emotion and parents' emotion coaching skills. Multilevel analyses were conducted to examine moderators of the intervention and regression analyses were conducted to examine mediators of program effects. Results showed greater benefits for intervention subgroups with high preintervention scores on youth anxiety. Parental internalizing difficulties and parental difficulties in emotion awareness/regulation did not moderate program effects. Mediation analyses supported emotion socialization theory and showed parents' who participated in the TINT parenting program reported improvements in their own awareness/regulation and emotion socialization, which were, in turn, related to reductions in youth internalizing difficulties. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Tuning in to Toddlers: Research Protocol and Recruitment for Evaluation of an Emotion Socialization Program for Parents of Toddlers.

Background: Parenting a toddler is a challenging experience for many parents with times of emotional dysregulation in both parent and child. Parenting interventions may be useful for parents to improve their ability to regulate emotions and respond to children's emotions in a way that assists the child to understand and regulate emotions (emotion competence). Tuning in to Toddlers (TOTS) is a new parenting program that aims to improve parents' emotion regulation, emotional responsiveness, and emotion coaching (aspects of emotion socialization) to promote optimal emotional development in toddlers, and prevent social and behavioral difficulties. This paper outlines the rationale, methodology, intervention, and recruitment used in a trial to establish program efficacy. Methods/Design: Parents of toddlers aged 18-36 months old were recruited through child care centers (CC) and maternal child health (MCH) centers in Melbourne, Australia and were allocated to either intervention or a 15-month wait-list control condition in a cluster-randomized controlled design. Inclusion criteria were a child in the age range at baseline attending one of the CC or MCH centers. Exclusion criteria were if the parent/carer had insufficient English to attend the intervention and complete measures. Parents in the intervention condition participated in the 6-session group TOTS program delivered by two facilitators using a structured manual and measures of program fidelity and acceptability. Participants in the wait-list control condition received the intervention after a 15-month waiting period. Participants completed measures at baseline, post-intervention (intervention participants only) and 15-month follow-up. Primary outcome measures included parent emotion socialization (parent-report and observed). Secondary outcomes included parent-reported parent functioning (emotion regulation and mental health), toddler social, emotional and behavioral functioning, and parent and toddler systemic cortisol stress (using hair samples). The study was designed to comply with the CONSORT statement and intervention reporting outlined using TIDieR. Results: Three hundred and six parents were recruited and completed baseline parent questionnaires, with a further 234 completing parent-child observation assessments, 235 parent cortisol, and 198 child cortisol. Discussion: This paper is a methodological description of the TOTS randomized controlled trial evaluation protocol. It outlines some of the challenges in recruiting parents of toddlers to parenting programs. Clinical Trial Registration: www.ClinicalTrials.gov, identifier ACTRN12615000 962538.

Pilot randomized controlled trial of Tuning Relationships with Music: Intervention for parents with a trauma history and their adolescent.

For parents who have experienced childhood interpersonal trauma, the challenges of parenting an adolescent may trigger memories of abuse, intensifying conflict, resulting in negative cycles of relating and poorer responsiveness to emotions when parenting. This study examined whether Tuning Relationships with Music, a dyadic therapy for parents and adolescents, increased responsive parent-adolescent interactions and parent emotion coaching whilst reducing conflict and adolescent mental health difficulties. Twenty-six parent-adolescent dyads were recruited if parents had a trauma history and the dyad were currently having high levels of conflict. Dyads were randomly allocated into intervention or wait-list control and completed questionnaires and observation assessments at baseline and 4-month post-baseline follow-up. Those allocated to the intervention condition participated in 8 sessions of Tuning Relationships with Music. TRIAL REGISTRATION: ANZCTR: 12615000814572. Parents and adolescents reported significant reductions in conflict. Parents in the intervention condition were observed to significantly improve their nonverbal communication, emotional responsiveness and non-reactivity toward their adolescent. Although parents reported they were less dismissive and punitive, and more encouraging of their adolescent's emotions, and both parents and adolescents reported improvements in the adolescent's mental health, these were not statistically significant. Findings suggest Tuning Relationships with Music may assist parents with a history of childhood interpersonal trauma and their adolescent to reduce conflict and increase responsive ways of relating that may positively impact the young person's mental health. Future trials with a larger sample are warranted.

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

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

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

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

An emotion-focused early intervention for children with emerging conduct problems.

This paper evaluates the real-world effectiveness of an emotion-focused, multi-systemic early intervention combining an emotion socialization parenting program with a child and school socio-emotional intervention for children with emerging conduct problems. Schools in lower socioeconomic areas of Victoria, Australia were randomized into intervention or wait-list control. Children in the first 4 years of elementary school were screened for behavior problems and those in the top 8 % of severity were invited to participate in the intervention. The study sample consisted of 204 primary caregivers and their children (Mage = 7.05, SD = 1.06; 74 % boys). Data were collected at baseline and 10 months later using parent and teacher reports and direct child assessment. Measures of parent emotion socialization, family emotion expressiveness, and children's emotion competence, social competence and behavior were administered. Results showed intervention parents but not controls became less emotionally dismissive and increased in empathy, and children showed better emotion understanding and behavior compared to control children. These outcomes lend support for an emotion-focused approach to early intervention in a real-world context for children with conduct problems.

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

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

Tuning in to Kids: improving emotion socialization practices in parents of preschool children--findings from a community trial.

BACKGROUND: This study evaluated a new prevention and early intervention parenting program: Tuning in to Kids. The program aims to improve emotion socialization practices in parents of preschool children and is based on research evidence that parents' responses to, and coaching of, their children's emotions influence emotional and behavioral functioning in children. METHODS: Two hundred and sixteen primary caregiver parents of children aged 4.0-5.11 years were randomized into an intervention or waitlist control group. Parents in the intervention condition attended a 6-session group parenting program plus two booster sessions. Assessment occurred pre-intervention, post-intervention and at six-month follow-up. Questionnaires assessed parent emotion awareness and regulation, parent beliefs and practices of emotion socialization (emotion dismissing, emotion coaching, empathy) and child behavior (parent and teacher report). Observation of emotion socialization practices and child emotional knowledge was conducted pre-intervention and at follow-up with 161 parent-child dyads. RESULTS: Parents in the intervention condition reported significant improvements in their own emotion awareness and regulation, increases in emotion coaching, and decreases in emotionally dismissive beliefs and behaviors. There were increases in parents' observed use of emotion labels and discussion of causes and consequences of emotions with their children. Child emotional knowledge improved, and reductions in child behavior problems were reported by parents and teachers. CONCLUSIONS: This study provides support for the efficacy of a parenting intervention targeting parent emotion socialization practices that lead to improved child emotional knowledge and behavior. This preventative intervention targeting parents' own emotion awareness and regulation, as well as emotional communication in parent-child relationships, is a promising addition to available parenting programs.