Investigating the effect of providing monetary incentives to participants on completion rates of referred co-respondents: An embedded randomized controlled trial. Study within a trial (SWAT) protocol.

Background: Parent-report questionnaires are a common method of generating data on child outcomes in mental health studies. A second report from another person who knows the child (co-respondent) is implemented to reduce bias and increase objectivity. The success of this approach is dependent on the engagement of co-respondents, which can be difficult. Financial incentives are used to increase data return in clinical trials, and to promote referral rates in online marketing. This protocol describes the use of an embedded randomised controlled trial (RCT) to investigate the effect of financial incentives on rates of co-respondent data completion. In the host RCT (of an online intervention designed to reduce the impact of a parent's anxiety on their child) index participants (i.e. parents) are asked to invite a co-respondent to complete measures on the index child. This study will test the hypothesis that providing monetary incentives to index participants will increase the outcome measure completion rate of co-respondents. Methods: Embedded RCT of two parallel groups. Participants in the intervention arm will be sent a £10 voucher if their chosen co-respondent completes online baseline measures. Participants in the control arm will not be offered payment regardless of their chosen co-respondent's behaviour. 1754 participants will take part. Analysis will compare co-respondent outcome measure completion rates between the two arms at baseline and follow-up. Conclusion: Findings from this study will provide evidence on the impact of offering payment to index participants on return rates of co-respondent data. This will inform resource allocation within future clinical trials.

Relations between bedtime parenting behaviors and temperament across 14 cultures.

Objectives: The present study examined parental sleep-supporting practices during toddlerhood in relation to temperament across 14 cultures. We hypothesized that passive sleep-supporting techniques (e.g., talking, cuddling), but not active techniques (e.g., walking, doing an activity together), would be associated with less challenging temperament profiles: higher Surgency (SUR) and Effortful Control (EC) and lower Negative Emotionality (NE), with fine-grained dimensions exhibiting relationships consistent with their overarching factors (e.g., parallel passive sleep-supporting approach effects for dimensions of NE). Methods: Caregivers (N = 841) across 14 cultures (M = 61 families per site) reported toddler (between 17 and 40 months of age; 52% male) temperament and sleep-supporting activities. Utilizing linear multilevel regression models and group-mean centering procedures, we assessed the role of between- and within-cultural variance in sleep-supporting practices in relation to temperament. Results: Both within-and between-culture differences in passive sleep-supporting techniques were associated with temperament attributes, (e.g., lower NE at the between-culture level; higher within-culture EC). For active techniques only within-culture effects were significant (e.g., demonstrating a positive association with NE). Adding sleep-supporting behaviors to the regression models accounted for significantly more between-culture temperament variance than child age and gender alone. Conclusion: Hypotheses were largely supported. Findings suggest parental sleep practices could be potential targets for interventions to mitigate risk posed by challenging temperament profiles (e.g., reducing active techniques that are associated with greater distress proneness and NE).

Effectiveness of a Web-Based Intervention to Prevent Anxiety in the Children of Parents With Anxiety: Protocol for a Randomized Controlled Trial.

BACKGROUND: Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50% higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviors are associated with reduced anxiety in their children. A brief UK-based group intervention delivered to parents within the UK National Health Service led to a 16% reduction in children meeting the criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a 9-module web-based version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks. OBJECTIVE: This study seeks to evaluate the feasibility of delivering this web-based intervention and assess its effectiveness in reducing child anxiety symptoms. METHODS:  This is the protocol for a randomized controlled trial (RCT) of a community sample of 1754 parents with self-identified high levels of anxiety with a child aged 2-11 years. Parents in the intervention arm will receive access to the web-based course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection is at months 6 and months 9-21. Intention-to-treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms, and well-being; parental anxiety and well-being; and parenting behaviors. RESULTS: Funding was received in April 2020, and recruitment started in February 2021 and is projected to end in October 2022. A total of 1350 participants have been recruited as of May 2022. CONCLUSIONS: The results of this RCT will provide evidence on the utility of a web-based course in preventing intergenerational transmission of anxiety and increase the understanding of familial anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT04755933; https://clinicaltrials.gov/ct2/show/NCT04755933. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40707.

Just as they expected: How parents' expectations about their unborn child's characteristics provide a context for early transactions between parenting and child temperament.

Prenatal expectations about what children will be like after birth may provide a context for how parents perceive their infant's actual temperament. We examined how these expectations and perceptions are associated and together predict early parenting behavior, with parenting behavior in turn predicting changes in temperament. Reports of 125 families (N = 122 fathers; N = 123 mothers; sample 1) about their expectations of their unborn child's temperament (negative affectivity, surgency, regulation, T1), their infant's temperament at 4 and 12 months post-partum (T2 and T3), and their hostile, responsive, warm, and overprotective parenting (T2) were included. We also included data from an independent sample of 168 mothers (sample 2), with the same measures, except that mothers reported on Big Five personality traits at T1. Results indicated that in both samples, parents' expectations were positively associated with perceptions of infant temperament. Prenatal expectations and newborn temperament independently predicted parenting behavior, and maternal and paternal parenting in turn predicted infant temperament at T3, controlling for infant temperament at T2. Although overall findings indicated associations between (expectations of) a more difficult temperament and more negative/less positive parenting, significant combinations of specific traits and parenting behaviors were sample-specific-indicating that more research is necessary to draw a conclusion about specific links. Both maternal and paternal expectations about their unborn child's temperament appear to carry over into the postpartum reality and provide a context for shaping early interactions between caregivers and their children, which may further shape the developing temperament of the child.

Mothers' and fathers' mind-mindedness in infancy and toddlerhood predict their children's self-regulation at preschool age.

The ability to regulate one's emotions and behaviors is essential for adaptive functioning in society. We investigated whether parental mind-mindedness-parents' tendency to treat their children as mental agents-in infancy and toddlerhood predicts school-age children's self-regulation. The sample consisted of 125 mostly Dutch and White families. We assessed mothers' and fathers' appropriate and nonattuned mind-related comments during free play with their 12- and 30-month-old child (70 girls and 55 boys). We measured children's physiological, temperamental, and behavioral self-regulation when children were 4 1/2 years old. Fathers' appropriate mind-related comments predicted children's higher temperamental and behavioral self-regulation and mothers' and fathers' nonattuned mind-related comments predicted children's lower physiological and temperamental self-regulation. Our findings emphasize the importance of both parents' mind-mindedness in children's socioemotional development. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effects of oxytocin and vasopressin administration on human fathers' sensitive and challenging parenting: A randomized within-subject controlled trial.

This randomized, double-blind, placebo-controlled within-subject study examined the effects of intranasal administration of oxytocin and vasopressin on fathers' sensitive and challenging parenting behaviors. Furthermore, we examined the moderating role of fathers' early childhood experiences. The sample consisted of 70 fathers with their 2- to 12-month-old infants. All fathers were assigned to each of the three experimental sessions (oxytocin, vasopressin, and placebo), on three separate days, with random order and intervening periods of one to two weeks. Sensitive and challenging parenting behaviors (CPB) were observed during a 10-minute free play task. Results showed no effects of vasopressin administration on paternal sensitivity. Fathers in the oxytocin condition were less sensitive than fathers in the placebo condition, and this effect was moderated by fathers' own childhood experiences: Fathers who reported higher levels of experienced parental love withdrawal were less sensitive in the oxytocin condition as compared to the placebo condition, whereas fathers with less experienced parental love withdrawal showed no difference in sensitivity between the oxytocin and placebo condition. No effects were found of oxytocin and vasopressin administration on fathers' CPB. Our results, although partly unexpected, are largely in line with previous literature showing that oxytocin administration can exert negative effects in individuals with adverse childhood experiences.

Challenging Parenting Behaviors in Ethnically Diverse Two-Parent Families in the United States: Association with Infants' Social Competence and Behavior Problems.

We used data from a sample of ethnically diverse first-time parents (N = 186) in the United States to examine differences between mothers' and fathers' challenging parenting behaviors (CPB) when infants were 9 months old as well as covariates of CPB. We also examined associations between CPB and infants' social competence and behavior problems when they were 12 months old. Results showed no differences between mothers and fathers in the level of CPB with their infants. Mothers with more depressive symptoms engaged in more CPB. Over and above the contributions of infants' gender and temperament and parents' education, mothers' and fathers' CPB was not associated with infants' social competence and behavior problems. This study expands our understanding of the universality of CPB and whether it is associated with social competence in ethnically diverse families.

The relation between early behavioural inhibition and later social anxiety, independent of attentional biases to threat.

Early behavioural inhibition, a temperamental characteristic defined by fearful, overly-sensitive, avoidant, or withdrawn reactions to the unknown, is a predictor of later social anxiety. However, not all behaviourally inhibited children develop anxiety problems, and attentional bias to threat has been proposed to moderate the relation between behavioural inhibition and anxiety. The current study aimed to further specify the relation between early behavioural inhibition and later social anxiety by testing this potentially moderating role of childhood attentional bias to threat. Behavioural inhibition was assessed during toddlerhood (age 2.5 years) using laboratory observations of children's behaviours in response to unknown objects and situations. When children were 7.5 years old, attentional bias was measured in 86 children (46 girls) using both a visual probe task and a visual search task with angry and happy faces. Child social anxiety was measured using questionnaires completed by the child and both parents, and clinical interviews conducted with both parents. Our results showed that while early behavioural inhibition was related to later social anxiety, there was no evidence for a moderation of this relation by attentional bias, suggesting that the relation between early fearful temperament and later social anxiety holds across children, independent of their attentional biases.

Links between television exposure and toddler dysregulation: Does culture matter?

Television exposure in early childhood has increased, with concerns raised regarding adverse effects on social-emotional development, and emerging self-regulation in particular. The present study addressed television exposure (i.e., amount of time watching TV) and its associations with toddler behavioral/emotional dysregulation, examining potential differences across 14 cultures. The sample consisted of an average of 60 toddlers from each of the 14 countries from the Joint Effort Toddler Temperament Consortium (JETTC; Gartstein & Putnam, 2018). Analyses were conducted relying on the multi-level modeling framework (MLM), accounting for between- and within-culture variability, and examining the extent to which TV exposure contributions were universal vs. variable across sites. Effects of time watching TV were evaluated in relation to temperament reactivity and regulation, as well as measures of emotional reactivity, attention difficulties, and aggression. Results indicated that more time spent watching TV was associated with higher ratings on Negative Emotionality, emotional reactivity, aggression, and attention problems, as well as lower levels of soothability. However, links between TV exposure and both attention problems and soothability varied significantly between cultures. Taken together, results demonstrate that increased time spent watching television was generally associated with dysregulation, although effects were not consistently uniform, but rather varied as a function of culturally-dependent contextual factors.

The unique contribution of blushing to the development of social anxiety disorder symptoms: results from a longitudinal study.

BACKGROUND: Self-conscious emotional reactivity and its physiological marker - blushing has been proposed to be an etiological mechanism of social anxiety disorder (SAD), but so far, untested in longitudinal designs. This study tested, for the first time, whether self-conscious emotional reactivity (indexed as physiological blushing) contributes to the development of SAD symptoms over and above social behavioral inhibition (BI), which has been identified as the strongest predictor of SAD development in early childhood. METHODS: One hundred fifteen children (45% boys) and their mothers and fathers participated at ages 2.5, 4.5, and 7.5 years. Social BI was observed at all time points in a stranger approach task, and physiological blushing (blood volume, blood pulse amplitude, and temperature increases) was measured during a public performance (singing) and watching back the performance at ages 4.5 and 7.5. Child early social anxiety was reported by both parents at 4.5 years, and SAD symptoms were diagnosed by clinicians and reported by both parents at 7.5 years. RESULTS: Higher social BI at 2.5 and 4.5 years predicted greater social anxiety at 4.5 years, which, in turn, predicted SAD symptoms at 7.5 years. Blushing (temperature increase) at 4.5 years predicted SAD symptoms at 7.5 years over and above the influence of social BI and early social anxiety. CONCLUSIONS: That blushing uniquely contributes to the development of SAD symptoms over and above social BI suggests two pathways to childhood SAD: one that entails early high social BI and an early onset of social anxiety symptoms, and the other that consists of heightened self-conscious emotional reactivity (i.e. blushing) in early childhood.

Intergenerational transmission of anxiety: linking parental anxiety to infant autonomic hyperarousal and fearful temperament.

BACKGROUND: Autonomic hyperarousal has been proposed as a dispositional risk factor for anxiety disorders (ADs). Therefore, we studied physiological arousal in offspring of fathers and mothers with and without ADs and whether infant hyperarousal predicts subsequent fearful temperament. METHODS: Infants (N = 128; age = 4 months) did a novel stimuli task (exposure to visual, olfactory, and acoustic stimuli and an unfamiliar male) and a habituation task (exposure to a repeated acoustic stimulus). Heart rate (HR) and heart rate variability (HRV) were measured during baseline, stimuli and post-stimuli rest. Parents' AD status and severity were measured using a diagnostic interview and their fearful temperament using a questionnaire. Child fearful temperament was measured at 4 months, 1 year and 2.5 years with observations during structured tasks. RESULTS: Parents' fearful temperament (significant in the habituation task), AD status (significant in the novel stimuli task) and AD severity (significant in both tasks) predicted a higher HR in their infants. Infants' higher HR reactivity to novel stimuli and diminished HR recovery at 4 months predicted a more fearful temperament during infancy and toddlerhood. Infants' higher HR at 4 months predicted a more fearful temperament at 2.5 years. CONCLUSIONS: Parental prenatal anxiety (disorders) predicted infants' autonomic arousal, which in turn predicted later fearful temperament in children. Outcomes suggest that autonomic hyperarousal is a dispositional risk factor of ADs.

Fathers' and Mothers' Early Mind-Mindedness Predicts Social Competence and Behavior Problems in Childhood.

Parental mind-mindedness, the parent's propensity to treat the child as an intentional agent, has repeatedly shown to promote children's development of social understanding and secure attachment. Less is known about whether the impact of maternal and paternal mind-mindedness extends to children's social and behavior problems. We investigated the combined effect of mothers' and fathers' (N = 104) mind-mindedness at 4, 12, and 30 months on children's social competence and externalizing and internalizing behavior problems at 4.5 years. Besides, we examined the stability, continuity, parental concordance, and inter-parental differences in the use of mind-related comments. Appropriate mind-mindedness (i.e., correct interpretations of the child's mental states) and nonattuned mind-mindedness (i.e., misinterpretations of the child's mental states) were observed during parent-child free-play interactions. Social competence, internalizing and externalizing behavior problems were assessed using both parents' reports. Hierarchical multiple regression analyses showed that, at 12 months, infrequent use of appropriate mind-related comments of both parents predicted children's externalizing problems, while their frequent use of nonattuned comments predicted children's low social competence. Furthermore, mothers' frequent use of nonattuned comments at 12 and 30 months and fathers' nonattuned comments at 30 months predicted children's externalizing behavior. The findings suggest that both parents' low use of mind-related comments, and frequent misinterpretations of their child's mind, may act as risk factors for later social and behavior problems of their child.

Cross-Cultural Differences in Temperament: Comparing Paternal ratings of US and Dutch infants.

This study conducted longitudinal comparisons of US and Dutch paternal ratings of temperament, measured via the Infant Behaviour Questionnaire-Revised, at 4 months (US n= 99; Dutch n= 127) and 12 months (US n= 66; Dutch n= 112) of age. US fathers rated their infant higher in the broad temperament trait Surgency, and its subscales vocal reactivity, high-intensity pleasure, and activity level. US fathers also rated their infants higher in Negative Emotionality, and its subscales of sadness, distress to limitations, and fear. Dutch infants received higher ratings in falling reactivity. Though the cultures did not differ in ratings of Orienting/regulatory capacity, US infants were higher on the subscale duration of orienting, and lower in soothability. Significant culture-by-age and culture-by-gender interactions were also noted. Overall, results are largely consistent with those reported for Dutch mothers (Sung et al., 2014) and speak to considerable differences in early temperament development between cultures viewed as largely similar because of their Western/individualistic orientations.

Fathers' challenging parenting behavior predicts less subsequent anxiety symptoms in early childhood.

Recent theories propose that (especially fathers') challenging parenting behavior (CPB) serves to reduce offspring's anxiety development, and that fearful children are more susceptible to parenting. Using a longitudinal design we explored whether more CPB (and less overprotection) of both parents, (1) separately, (2) relatively, and (3) jointly predicts less anxiety in early childhood, and (4) whether child fearful temperament moderates these relations. Participants were 132 couples with their first-born child. Child fearful temperament was observed at 4 months and 1 year, and parents' CPB and overprotection at 1 and 2.5 years. Child anxiety symptoms were assessed at 2.5 and 4.5 years. Multilevel analyses showed that more CPB and, unexpectedly, more overprotection predicted less child anxiety. Relatively, fathers' CPB and mothers' overprotection predicted less anxiety. An interaction showed that if one parent shows low CPB, the other parent's higher CPB predicts less child anxiety. A trend interaction suggested that fathers' CPB predicts less anxiety most strongly for fearful children. Thus, fathers' CPB appears to play a protective role in anxiety development, possibly in particular for children most vulnerable to develop anxiety problems. Parents can compensate for a less challenging partner. The finding that maternal overprotection mitigates child anxiety requires further investigation.

Parental negative emotions are related to behavioral and pupillary correlates of infants' attention to facial expressions of emotion.

Previous evidence revealed links between maternal negative emotions and infants' attention to facial expressions of emotion in clinical and community samples. This study investigated the associations between infants' attention to emotional faces and infants' and parents' negative emotions in a community sample. Infants' (N = 57, Mage = 14.26 months) fixations and pupil responses to fearful, sad, angry versus happy and neutral faces were measured with an eye-tracker. Mothers' and fathers' negative emotions (negative affect, depression, and anxiety), and infants' negative temperament were measured with questionnaires. Infants looked longer at fearful than happy or neutral faces, while they showed less pupil dilation to fearful than to happy or neutral faces. Higher levels of maternal negative emotions were related to less pupillary arousal to emotional facial expressions in infants, while paternal negative emotions did not predict infants' pupil responses. Exploratory analyses suggested a significant link between paternal but not maternal negative emotions and infants' fixations that was moderated by infant negative temperament: Higher levels of negative emotions in fathers were related to longer fixations in children with high levels of negative temperament, while it was related to shorter fixations in infants with low levels of negative temperament. The findings provide support for the idea that exposure to mothers' and fathers' negative emotions play a role on the development of infants' attention to facial expressions in typical development.

Mothers' and fathers' mind-mindedness influences physiological emotion regulation of infants across the first year of life.

The main aim of this study was to test whether mothers' (n = 116) and fathers' (n = 116) mind-mindedness predicts infants' physiological emotion regulation (heart rate variability; HRV) across the first year of life. Three hypotheses were examined: (a) parents' mind-mindedness at 4 and 12 months predicts infants' HRV at 12 months over and above infants' initial HRV levels at 4 months, (b) mothers' and fathers' mind-mindedness independently predict infant HRV, and (c) the effects of mind-mindedness on infant HRV (partially) operate via parenting behaviour. Infants' HRV was assessed during rest and a stranger approach. Mind-mindedness was assessed by calculating the proportions of appropriate and non-attuned mind-related comments during free-play interactions, and parenting quality was observed at 4 and 12 months in the same interactions. Path analyses showed that mothers' appropriate mind-related comments at 4 and 12 months predicted higher baseline HRV at 12 months, whereas mothers' non-attuned comments predicted lower baseline HRV at 12 months. Similar, but concurrent, relations were found for fathers' appropriate and non-attuned mind-related comments and infant baseline HRV at 12 months. In addition, fathers' appropriate mind-related comments showed an indirect association with infant baseline HRV at 12 months via fathers' parenting quality. With regard to infant HRV reactivity during the stranger approach, mothers' appropriate mind-related comments at 4 months and fathers' non-attuned mind-related comments at 12 months predicted a larger HRV decline during the stranger approach at 12 months. Infants' HRV at 4 months did not predict parents' later mind-mindedness. The results indicate that mothers' and fathers' appropriate and non-attuned mind-related speech uniquely impacts the development of infants' physiological emotion regulation.

Parental Expressions of Anxiety and Child Temperament in Toddlerhood Jointly Predict Preschoolers' Avoidance of Novelty.

This study investigated the link between (a) parents' social trait and state anxiety and (b) children's fear and avoidance in social referencing situations in a longitudinal design and considered the modulating role of child temperament in these links. Children were confronted with a stranger and a robot, separately with their father and mother at 1 (N = 122), at 2.5 (N = 117), and at 4.5 (N = 111) years of age. Behavioral inhibition (BI) was separately observed at 1 and 2.5 years. Parents' social anxiety disorder (SAD) severity was assessed via interviews prenatally and at 4.5 years. More expressed anxiety by parents at 4.5 years was not significantly linked to more fear or avoidance at 4.5 years. High BI children were more avoidant at 4.5 years if their parents expressed more anxiety at 2.5 years, and they were more fearful if the parents had more severe forms of lifetime SAD. More severe lifetime forms of SAD were also related to more pronounced increases in child fear and avoidance over time, whereas parents' expressions of anxiety predicted more pronounced increases in avoidance only from 2.5 to 4.5 years. High BI toddlers of parents with higher state and trait anxiety become more avoidant of novelty as preschoolers, illustrating the importance of considering child temperamental dispositions in the links between child and parent anxiety. Moreover, children of parents with more trait and state anxiety showed more pronounced increases in fear and avoidance over time, highlighting the importance of early interventions targeting parents' SAD.

Concurrent and Predictive Associations Between Infants' and Toddlers' Fearful Temperament, Coparenting, and Parental Anxiety Disorders.

This study investigated the bidirectional relations between two dimensions of coparenting (the way parental figures cooperate in parenting), undermining and support, and child fearful temperament longitudinally from infancy to toddlerhood, while inspecting the moderating role of parents' anxiety disorders. Questionnaire data on coparenting and child fearful temperament were obtained from 135 mothers, fathers, and their firstborns at 4 months, 12 months, and 30 months. Parental anxiety disorder severity was assessed with a semistructured interview before the birth of the child. Multilevel analysis revealed that, across measurement moments, undermining coparenting, but not supportive coparenting, was concurrently related to higher child fearful temperament. Parental anxiety disorder severity was related to more undermining coparenting but not to supportive coparenting. No moderation effects for parental anxiety disorder or for parent gender were found in the relations between coparenting and child fearful temperament. We conclude that more parental anxiety is related to a lower quality of the coparenting relationship, which in turn is associated to more child fearful temperament. More specifically, it appears that undermining coparenting, and not supportive coparenting, is related to child fearful temperament and parental anxiety disorder severity. Our results suggest that undermining coparenting, by both father and mother, is one of the mechanisms that may contribute to the intergenerational transmission of anxiety from parent to child. The coparenting relationship may be a useful target in the prevention and treatment of child anxiety.