An Updated Account on Parents' Use of and Attitudes Towards Time-Out.

Time-out (TO) is a well-established technique for effectively managing childhood conduct problems, yet there is increasing controversy around its use. Using a mixed-methods approach, we investigated the impact of recent criticisms against TO on parents' use of and attitudes towards it. A community sample of parents (N = 297, Mage = 37.14) completed an online survey (Study 1) to investigate use of and acceptability of TO. Results showed that 57.91% of parents reported using TO, slightly lower than past estimates. Perceived effectiveness and trust in clinicians predicted TO acceptability. To thoroughly examine negative attitudes towards TO, parents who did not use TO (N = 17, Mage = 38.29) participated in individual interviews (Study 2). Amongst other findings, Study 2 found that parents view TO as punitive and contrary to their value of connection. We discuss implications for parenting interventions, dissemination of parenting information, and future research.

Patterns and Predictors of Different Youth Responses to Attachment-Based Parent Intervention.

OBJECTIVE: Few studies have evaluated attachment-based parent interventions for pre-teens and teens, and in particular, differential adolescent trajectories of response. This study examined distinct patterns, and multi-level predictors, of intervention response among youth with serious behavioral and mental health problems whose parents participated in Connect, an attachment- and trauma-informed parent program. METHOD: Participants included 682 parents (Mage = 42.83, 86% mothers) and 487 youth (Mage = 13.95, 53% female, 28.1% ethnic minority) enrolled in a community-based evaluation of Connect. Parents and youth reported on youth externalizing and internalizing problems (EXT and INT) at six time points from baseline through 18-months post-intervention. Demographic and youth and family level predictors were assessed at baseline. RESULTS: Growth mixture modeling revealed three distinct trajectory classes in both the parent and youth models based on different patterns of co-occurring EXT and INT and degree of improvement over time. Youth with severe EXT showed the largest and fastest improvement, and, interestingly, were characterized by higher callous-unemotional traits and risk-taking at program entry. Youth with comorbid EXT/INT demonstrated a partial or moderate response to intervention in the parent and youth model, respectively, and were characterized by more attachment anxiety at baseline. Most youth showed relatively moderate/low levels of EXT/INT at baseline which gradually improved. Caregiver strain also predicted trajectory classes. CONCLUSIONS: These results have significance for tailoring and personalizing interventions for high-risk youth and provide new understanding regarding the profiles of subgroups of youth who show different responses to an attachment-based parent intervention.

Indirect Effects of Early Parenting on Adult Antisocial Outcomes via Adolescent Conduct Disorder Symptoms and Callous-Unemotional Traits.

Parental harsh punishment and warmth have been associated with child and adolescent conduct disorder (CD) symptoms and callous-unemotional (CU) traits (i.e., lack of guilt, empathy, and deficient affect); however, it is unclear whether the effect of these parenting behaviors on antisocial outcomes persists into adulthood. Thus, the present study aimed to test whether adolescent CD symptoms and CU traits mediate the effect of parental harsh punishment and warmth on adult antisocial outcomes (i.e., antisocial personality disorder (ASPD), externalizing psychopathology, partner violence, and violent and substance crime). Participants included the high-risk control and normative samples from the Fast Track project (N =753, male = 58%, African American = 46%). Harsh punishment during kindergarten through grades 1-2 predicted higher adolescent CD symptoms, and directly observed warmth during kindergarten through grades 1-2 predicted lower adolescent CU traits. Adolescent CD symptoms predicted greater adult substance crime, and adolescent CU traits predicted greater adult ASPD symptoms and externalizing psychopathology. Further, adolescent CD symptoms indirectly accounted for the effect of parental harsh punishment on adult substance crime, and adolescent CU traits indirectly accounted for the effect of parental warmth on ASPD symptoms and externalizing psychopathology. Findings support the importance of early interventions targeting parenting behaviors to reduce risk for the development of antisocial behavior, and inform developmental models of antisocial behavior in adolescence through adulthood.

Capturing Parenting as a Multidimensional and Dynamic Construct with a Person-Oriented Approach.

Although parenting is one of the most commonly studied predictors of child problem behavior, few studies have examined parenting as a multidimensional and dynamic construct. This study investigated different patterns of developmental trajectories of two parenting dimensions (harsh discipline [HD] and parental warmth [PW]) with a person-oriented approach and examined the associations between different parenting patterns and child externalizing problems and callous-unemotional traits. Data were drawn from the combined high-risk control and normative sample (n = 753) of the Fast Track Project. Parent-reported HD and observer-reported PW from kindergarten to grade 2 were fit to growth mixture models. Two subgroups were identified for HD (low decreasing, 83.0 %; high stable, 17.0 %) and PW (high increasing, 78.7 %; low increasing, 21.3 %). The majority of parents (67.0 %) demonstrated the low decreasing HD and high increasing PW pattern, while the prevalence of the high stable HD and low increasing PW pattern was the lowest (6.8 %). Parenting satisfaction, parental depression, family socioeconomic status, and neighborhood safety predicted group memberships jointly defined by the two dimensions. Children from the high stable HD and low increasing PW pattern showed the highest levels of externalizing problems in grades 4 and 5. Children from the low decreasing HD and low increasing PW pattern showed the highest levels of callous-unemotional traits in grade 7. These findings demonstrate the utility and significance of a person-oriented approach to measuring parenting as a multidimensional and dynamic construct and reveal the interplay between HD and PW in terms of their influences on child developmental outcomes.

Expression and Regulation of Attachment-Related Emotions in Children with Conduct Problems and Callous-Unemotional Traits.

Callous-unemotional traits (CU) are defined by low responsiveness to, and unfeeling disregard for the emotions of others. There is controversial evidence, however, that children with high CU traits can demonstrate affective responsiveness under certain conditions, namely those associated with attachment threat. We tested this using 'fear + amusing' and 'attachment rich' stimuli from the Lion King film. Of N = 76, 4-14 years old children, 56 were clinic-referred children divided into high and low CU traits groups, and 20 children were drawn from the community. Participants watched film sequences of fearful, attachment-related and neutral stimuli and their affective responses and emotion-regulation strategies were coded by independent observers. Children in the high CU traits group were able to disengage from the fear stimuli by showing more 'happiness' to a brief slapstick interlude. In the attachment scenario, high CU children expressed similar or trends toward higher emotional responses and emotion regulation strategies, compared to low-CU children and control children. The results support the idea that high CU children may have the potential for emotional responsiveness to complex emotional stimuli in attachment contexts. Implications of these results for the development of interventions are discussed.

Common elements of adolescent prevention programs: minimizing burden while maximizing reach.

A growing number of evidence-based youth prevention programs are available, but challenges related to dissemination and implementation limit their reach and impact. The current review identifies common elements across evidence-based prevention programs focused on the promotion of health-related outcomes in adolescents. We reviewed and coded descriptions of the programs for common practice and instructional elements. Problem-solving emerged as the most common practice element, followed by communication skills, and insight building. Psychoeducation, modeling, and role play emerged as the most common instructional elements. In light of significant comorbidity in poor outcomes for youth, and corresponding overlap in their underlying skills deficits, we propose that synthesizing the prevention literature using a common elements approach has the potential to yield novel information and inform prevention programming to minimize burden and maximize reach and impact for youth.

The longitudinal link between parenting and child aggression: the moderating effect of attachment security.

This study examined whether infant attachment security moderates the association between parenting in preschool and later aggressive behavior among a sample of children at high risk for developing conduct problems. Participants were 82 adolescent mother-child dyads recruited from the community. Infant attachment status at age 1 year was measured using the Strange Situation. When children were aged 4.5 years, mothers reported on their self-efficacy in regards to parenting, and mothers' positive parenting and criticism were coded from direct observations of parent-child interactions. In grade 1, mothers reported on their children's aggressive behavior. Infant secure attachment significantly moderated the association between observed maternal criticism and child aggression. That is, among insecurely attached children, higher levels of maternal criticism were associated with more severe aggression. This longitudinal finding suggests that a secure attachment may buffer the deleterious effects of harsh parenting on child aggression.

Emotion socialization style in parents of children with callous-unemotional traits.

Children with callous-unemotional (CU) traits manifest a range of deficits in their emotional functioning, and parents play a key role in socializing children's understanding, experience, expression, and regulation of emotions. However, research examining emotion-related parenting in families of children with CU traits is scarce. In two independent studies we examined emotion socialization styles in parents of children high on CU traits. In Study 1, we assessed parents' self-reported beliefs and feelings regarding their own and their child's emotions, in a sample of 111 clinic-referred and community children aged 7-12 years. In Study 2, we directly observed parents' responding to child emotion during an emotional reminiscing task, in a clinic sample of 59 conduct-problem children aged 3-9 years. Taken together, the results were consistent in suggesting that the mothers of children with higher levels of CU traits are more likely to have affective attitudes that are less accepting of emotion (Study 1), and emotion socialization practices that are more dismissing of child emotion (Study 2). Fathers' emotion socialization beliefs and practices were unrelated to levels of CU traits. Our findings provide initial evidence for a relationship between CU traits and parents' emotion socialization style, and have significant implications for the design of novel family-based interventions targeting CU traits and co-occurring conduct problems.

How do kinship and foster caregivers differ in their conceptualization of family connectedness?

BACKGROUND: In out-of-home care in Australia and internationally, there is an increasing preference to place children in kinship than foster care placements as it is assumed that kinship care promotes caregiver, family, and cultural connectedness. However, little research has examined whether and how the quality of these connections differ between kinship and foster care. OBJECTIVE: We utilized qualitative methodology to provide a richer, strengths-based exploration of caregivers' perspectives on the caregiver-child relationship and other connections (i.e., family, culture) in kinship compared to foster care. PARTICIPANTS AND SETTING: Sixty-six kinship (N = 31) and foster (N = 35) caregivers of 8- to 16-year-olds in Australia. METHODS: Kinship and foster caregivers provided Five-Minute Speech Samples about their child and the caregiver-child relationship. Thematic analysis was used to explore the ways caregivers described family relationships and connectedness. RESULTS: Results highlighted the value caregivers place on strong attachment relationships with their children and the skills that help them develop a safe haven for children. Caregiver groups also differed in their discussions of commitment to the child and family and cultural connectedness, with kinship caregivers more likely to emphasize the strengths and challenges of birth family relations and the importance of cultural connectedness than foster caregivers. CONCLUSIONS: Our findings highlight the ways in which kinship and foster caregivers emphasize different aspects of family and cultural connectedness which can be used to inform policy and practice in an area currently lacking evidence.

Childhood Experiences of Alternative Care and Callousness/Unemotionality: A Conceptual Model, Scoping Review, and Research Agenda.

Individuals with experiences of alternative care (AC; i.e., out-of-home care and institutional care) are at high risk for various mental health and relational problems stemming from exposure to serious attachment disruptions, loss, and complex trauma. Yet, despite the interpersonal context of their significant adversities, surprisingly there is scant research explicitly focusing on callousness/unemotionality (e.g., lack of guilt, callous disregard for others) in this population. This paper provides the first conceptual model for, and systematic scoping review of, callousness/unemotionality in children and young people with experiences of AC. In a comprehensive search of nine databases, 22 articles involving samples of participants in AC or with histories of AC, were identified for inclusion. The pattern of findings revealed that callous-unemotional and psychopathic traits are elevated in children and young people with AC experiences, and positively associated with AC. Moreover, results showed associations between these traits and various psychosocial correlates, most consistently with externalizing and internalizing problems and attachment-related problems. Only two intervention studies were located, one of which found benefits of training and supporting foster caregivers for reducing callous-unemotional traits. These findings are discussed with respect to gaps in the literature, future research directions, and trauma-informed practice to assess and treat callousness/unemotionality in children and young people with experiences of AC.

Attachment and callous-unemotional traits in children with early-onset conduct problems.

BACKGROUND: Antisocial children with callous-unemotional (CU) traits appear to be disconnected from other people's emotions; although little is known about their experience of the parent-child emotional bond. This study examined parent-child attachment relationships and levels of CU traits in conduct-problem children. METHOD: Attachment classifications in boys (M = 6.31 years) with disruptive behaviour disorders were assessed using the Manchester Child Attachment Story Task. Multiple informants rated children's CU traits. RESULTS: Independent of severity of conduct problems, high levels of CU traits were associated with more insecure attachment; specifically, disorganised attachment representations; however, CU traits were not associated with avoidant representations. CONCLUSIONS: Among conduct-problem children, those higher on CU traits appear to be at increased risk of experiencing disruptions in parent-child attachment relationships; attachment may be an important area for treatment and prevention efforts for CU traits in young children.

Emotional communication in families of conduct problem children with high versus low callous-unemotional traits.

This study examined relationships between parent-child emotional communication and callous-unemotional (CU) traits and conduct problems. References to negative and positive emotions made by clinic-referred boys (3-9 years) and their parents were coded from direct observations of family interactions involving the discussion of shared emotional experiences. Although frequencies of parents' emotion expression did not generally relate to levels of CU traits, boys higher on CU traits were observed to be more expressive of negative emotions in conversation with their caregivers-specifically for sadness and fear. Independent coders did not judge these children to be less genuine in their emotion expression compared to their low-CU counterparts. We also examined whether CU traits moderated the relationship between parents' focus on emotions and conduct problem severity. Higher levels of maternal focus on negative emotions were found to be associated with lower conduct problems in high-CU boys but related to higher conduct problems in low-CU boys. Frequencies of fathers' emotional communication were unrelated to either child CU traits or conduct problems. We discuss the implications of these findings for the conceptualization of CU traits in preadolescent children, and interventions for conduct problems in children elevated on these traits.

Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis.

Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child's underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0-18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = - 0.17) and INT (SMD = - 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.

Do callous-unemotional traits moderate the relative importance of parental coercion versus warmth in child conduct problems? An observational study.

BACKGROUND: Research suggests that parenting has little influence on the development of antisocial behavior in children with callous-unemotional (CU) traits. We aimed to extend and improve on prior studies examining the moderating role of CU traits on associations between parenting and conduct problems, by using independent observations of two key dimensions of parenting: coercion and warmth. METHODS: The participants included clinic-referred conduct-disordered boys (4-12 years; N = 95) and their families. Coercive parenting was coded from observations of family interaction and parental warmth was coded from Five-Minute Speech Samples. CU traits and conduct problems were rated by multiple informants. RESULTS: In both mothers and fathers, CU traits moderated links between observed parenting and conduct problems. Specifically, coercive parenting was more strongly positively associated with conduct problems in boys with lower levels of CU traits, whereas parental warmth was more strongly negatively associated with conduct problems in boys with higher levels of CU traits. CONCLUSIONS: These findings suggest that different dimensions of parenting may need to be targeted in the treatment of early onset conduct problems in children high and low on CU traits.

Assessing relational schemas in parents of children with externalizing behavior disorders: reliability and validity of the Family Affective Attitude Rating Scale.

Direct observational assessment of parent-child interaction is important in clinical intervention with conduct-problem children, but is costly and resource-intensive. We examined the reliability and validity of a brief measure of parents' relational schemas (RSs) regarding their child. Children (aged 4 to 11years) and their families receiving treatment at a clinic for externalizing behavior problems (n=150) or mood/developmental disorders (n=28) were assessed using a multi-method, multi-informant procedure. RSs were coded from Five-Minute Speech Samples (FMSS) using the Family Affective Attitude Rating Scale (FAARS), and were compared with directly observed parent-child interaction and questionnaire measures of family and parental dysfunction and conduct problems. Mothers' and fathers' RS scales were internally consistent and could be reliably coded in under 10min. Less positive RSs and more negative RSs were associated with higher rates of child conduct problems, and were more characteristic of the speech samples of parents of children with externalizing disorders, compared with clinic control parents. RSs demonstrated some associations with parenting behavior and measures of family functioning and symptoms of parental psychopathology, and predicted conduct problems independently of observed parental criticism. The results demonstrate the reliability and validity of the FAARS assessment of parental RSs in clinic-referred families. This brief measure of parent-child dynamics appears well-suited to 'real-world' (i.e., community) clinical settings in which intensive methods of observation are often not feasible.

Insecure Attachment, Maladaptive Personality Traits, and the Perpetration of In-Person and Cyber Psychological Abuse.

Although past findings show that insecure attachment and maladaptive personality traits confer risk for perpetrating intimate partner violence (IPV), little is known about how these factors may underpin psychological abuse (PA) committed in-person and via technology. This study examined whether borderline personality disorder (BPD) traits and psychopathic traits account for indirect effects of insecure attachment on the perpetration of face-to-face and cyber PA. Participants included a community-based sample (N = 200; Mage = 22.28 years) in Australia who completed a battery of online questionnaires. Results from bivariate correlations showed that elevated levels of attachment anxiety and avoidance, and higher scores on BPD traits and psychopathic traits, were significantly associated with the perpetration of both face-to-face and cyber PA. Findings from mediation analysis indicated that attachment anxiety was indirectly linked with the perpetration of both forms of PA via elevated scores on BPD traits and psychopathic traits. High levels of psychopathic traits accounted for the indirect effects of attachment avoidance on both forms of PA. Results support the theory that insecure attachment and maladaptive personality functioning might be involved in the development and/or maintenance of the perpetration of PA. These findings have implications for preventive and treatment programs for the perpetration of IPV in terms of shedding new light on potential risk factors for engagement in face-to-face and technology-based PA.

Pilot randomized controlled trial of an attachment- and trauma-focused intervention for kinship caregivers.

BACKGROUND: Kinship care placements are increasing in many Western countries, however families in kinship care are underserved partly due to the lack of evidence-based interventions addressing their unique needs. OBJECTIVE: We conducted a pilot randomized controlled trial (RCT) to examine research feasibility and the acceptability, fidelity, and preliminary outcomes of an attachment- and trauma-focused intervention for kinship caregivers in Australia. PARTICIPANTS AND SETTING: Participants included 26 kinship caregivers (Mage = 55.00 years; 54% grandparents) with youth (Mage = 10.58 years; 38% female), and 19 practitioners from child protection, out-of-home care and other services. METHOD: Kinship caregivers were randomized to Connect for Kinship Parents (Connect-KP) or care-as-usual (CAU), and completed assessments at baseline, post-intervention, and 6-month follow-up. Placement changes were evaluated at 6-month follow-up. A subset of practitioners received both training and supervision in implementing Connect-KP, and their videorecorded sessions were coded for fidelity. RESULTS: Practitioners rated the training highly and demonstrated excellent fidelity to program content and process. Results supported the research feasibility and all kinship caregivers reported high levels of program satisfaction and had very high attendance and completion rates. Direction of effects favored Connect-KP vs. CAU for all nine caregiver and youth outcomes, with the largest effects observed for significant reductions in caregiver strain, caregiver psychological aggression, and youth affect suppression following intervention. At 6-month follow-up, more youth from CAU (15%) vs. Connect-KP (0%) experienced an unplanned placement change. CONCLUSIONS: Our findings show promise of Connect-KP as a potentially effective intervention that can be successfully implemented in child welfare services, and provide impetus for a larger-scale RCT.

Does Kinship vs. Foster Care Better Promote Connectedness? A Systematic Review and Meta-Analysis.

Internationally, there is an increasing trend toward placing children in kinship vs. foster care. Prior research suggests that children in kinship care fare better compared to children in foster care; however, the reasons for this remain unclear. We conducted a systematic review and meta-analysis to examine the hypothesis that kinship care better preserves children's connectedness to caregiver, birth family, culture, and community; which, in turn, is associated with more optimal child outcomes. Thirty-one studies were reviewed that compared children aged 0-18 years in kinship care vs. foster care on levels of connectedness, three of which had outcomes that permitted meta-analysis. Findings indicated that children in kinship vs. foster care were more likely to feel connected to family in general; however, there was not a clear advantage for kinship vs. foster care for caregiver, birth parent, cultural, and community connectedness. While levels of connectedness were generally associated with more adaptive child outcomes for children in both kinship and foster care, no reviewed studies examined the hypothesis that children's connectedness may mediate the relationship between placement type and child well-being and placement outcomes. Results are discussed with respect to limitations and policy implications of the current evidence-base and the need for more rigorous research to help identify how to improve child well-being in home-based care.

Interpersonal attachment, early family environment, and trauma in hoarding: A systematic review.

The formation of intense emotional attachments to objects, difficulty parting with possessions, and the extreme accumulation of clutter are key features of Hoarding Disorder (HD). Although substantial literature implicates processes such as dysfunctional beliefs and maladaptive emotional cycles in HD, little is known about the vulnerability factors that lead to their development and hoarding symptomatology. The current review sought to systematically collate and integrate findings from studies investigating the relationship between hoarding symptoms and three proposed vulnerability factors: i) interpersonal attachment, ii) early family environment, and iii) traumatic or adverse life events. A comprehensive search of the databases PsycInfo, PubMed, and Scopus identified a total of 39 studies for inclusion. The results presented a complex pattern that supported the presence of relationships between insecure attachment, cold and controlling family experiences, and exposure to adverse life events with increased hoarding severity. However, the specificity of these factors to HD over other clinical groups remains unclear and findings are limited by the heterogenous and small number of studies. We conclude by discussing the clinical implications and limitations of these findings and propose new directions for future research.

The Role of Emotion Understanding in the Development of Aggression and Callous-Unemotional Features across Early Childhood.

Although prior research suggests that children show rapid change in socioemotional functioning and aggression throughout early childhood, little is known about how these factors may be associated with the development of callous-unemotional (CU) features. This study investigated the parallel development of, and reciprocal relationships between, emotion understanding (EU) and aggression across early childhood, as well as how they play a role in the development of CU features. Parallel latent growth curve modeling was used to examine longitudinal reciprocal relationships between EU and aggression in a sample of 498 primarily Black (i.e., African-American or Afro-Caribbean) preschoolers (49.5% male, 89.2% Black, Mage = 4.1), followed with six waves over a 45-month period from pre-kindergarten through grade 2. CU features were included as a baseline covariate, as well as an outcome, of EU and aggression growth factors. Children with lower levels of EU at age 4 displayed higher linear increases in aggression over time. EU at age 4 had a significant indirect effect on CU features at age 8 via its association with linear increases in aggression. Findings suggest that EU is influential in the early development of aggression, which may in turn influence the development or exacerbation of CU features. Children's EU in early childhood, especially concerning others' distress, may be an important component of preventive intervention efforts for young children at risk for serious antisocial behavior.