Childhood maltreatment and resting-state network connectivity: The risk-buffering role of positive parenting.

Unraveling the neurobiological foundations of childhood maltreatment is important due to the persistent associations with adverse mental health outcomes. However, the mechanisms through which abuse and neglect disturb resting-state network connectivity remain elusive. Moreover, it remains unclear if positive parenting can mitigate the negative impact of childhood maltreatment on network connectivity. We analyzed a cohort of 194 adolescents and young adults (aged 14-25, 47.42% female) from the Neuroscience in Psychiatry Network (NSPN) to investigate the impact of childhood abuse and neglect on resting-state network connectivity. Specifically, we examined the SAN, DMN, FPN, DAN, and VAN over time. We also explored the moderating role of positive parenting. The results showed that childhood abuse was linked to stronger connectivity within the SAN and VAN, as well as between the DMN-DAN, DMN-VAN, DMN-SAN, SAN-DAN, FPN-DAN, SAN-VAN, and VAN-DAN networks about 18 months later. Positive parenting during childhood buffered the negative impact of childhood abuse on network connectivity. To our knowledge, this is the first study to demonstrate the protective effect of positive parenting on network connectivity following childhood abuse. These findings not only highlight the importance of positive parenting but also lead to a better understanding of the neurobiology and resilience mechanisms of childhood maltreatment.

Effect of the INSIGHT Responsive Parenting Intervention on Parenting and Child Behavior at Ages 3 and 6 Years.

OBJECTIVES: To examine effects of the INSIGHT study responsive parenting (RP) intervention on reported and observed general parenting and child behavior during early and middle childhood. STUDY DESIGN: Primiparous mother-newborn dyads (n = 279) were randomized to RP intervention or a safety control, with intervention content delivered at research nurse home visits at infant ages 3-4, 16, 28, and 40 weeks and research center visits at 1 and 2 years. At age 3 (n = 220) and 6 years (n = 171) parenting and child behavior were observed during dyadic interactions and coded using the Iowa Family Interaction Rating Scales. Mothers also reported on child behavior (age 3) and aspects of general parenting (age 6) via the Child Behavior Checklist and The Comprehensive General Parenting Questionnaire, respectively. RESULTS: RP group children had fewer mother-reported externalizing (F = 8.69, P = .004) and problem behaviors at age 3 (F = 4.53, P = .03), and higher observed prosocial (F = 4.73, P = .03) and lower antisocial (ie, externalizing; F = 4.79, P = .03) behavior at age 6 vs controls. There were no study group differences in observed maternal sensitivity at age 3 or 6 years. At age 6, RP group mothers reported higher use of structure defined by establishing consistent rules and routines (F = 5.45, P = .02) and organization of their child's environment (F = 7.12, P = .008) compared with controls. CONCLUSIONS: The INSIGHT RP intervention increased parental organization of the child's environment to facilitate competence, and had beneficial impacts on child behavior at 3 and 6 years. No impacts were found on maternal sensitivity in childhood. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01167270.

Warmth and reciprocity with mothers, and young children's resilience to exposure to community violence in Colombia: findings from the La Sabana Parent-Child Study.

BACKGROUND: Exposure to community violence is common worldwide and is associated with emotional and behavioural problems in children. Little is known about sources of resilience. Building on our previous work on the contribution of callous-unemotional (CU) traits to child aggression in Colombia, we examined whether positive parenting is protective for children whose families are exposed to community violence. METHODS: Families were recruited from three demographically contrasting regions of Colombia. The sample comprised 235 children aged 3.5 years and their mothers, of whom 220 (93%) were followed up at age 5.0 years. Positive parenting was assessed as the average of maternal warmth and reciprocity, and as praise, and negative parenting as the average of negative affect and conflict seen in video recordings of standardized procedures. CU traits and oppositional defiant disorder were assessed by maternal report at ages 3.5 and 5.0 years, and mothers reported exposure to community violence over the 18 months between assessments. A range of potential confounds was included in adjusted analyses. RESULTS: In the families who were exposed to community violence, but not in the unexposed, maternal warmth and reciprocity were associated prospectively with lower CU traits (interaction, p = .007). In the exposed group maternal warmth and reciprocity explained 10% of the variance (ß = -.34, p = .001). Maternal praise was not associated with CU traits. Maternal negative parenting predicted higher CU traits as the main effect but not in interaction with community violence exposure. CONCLUSIONS: Maternal warmth and reciprocity with young children may promote resilience in the face of community violence. Programmes to enhance these protective processes may be needed especially where prospects for reducing community violence are limited. The centrality of parents for these children highlights the plight of those exposed to community violence, and also either separated from parents or orphaned.

The thriving kids and parents schools project: protocol of an incomplete stepped wedged cluster randomised trial evaluating the effectiveness of a Triple P seminar series.

BACKGROUND: The COVID-19 pandemic disrupted the normality of daily life for many children, their families, and schools, resulting in heightened levels of anxiety, depression, social isolation, and loneliness among young people. An integrated public health model of interventions is needed to address the problem and to safeguard the mental health and wellbeing of children. The Triple P - Positive Parenting Program is one system of parenting support with a strong evidence-base and wide international reach. When implemented as a public health approach, Triple P has demonstrated population level positive effects on child wellbeing. This study will be the first large-scale, multi-site randomised controlled trial of a newly developed, low-intensity variant of Triple P, a school-based seminar series, as a response to the impacts of the pandemic. METHODS: The evaluation will employ an Incomplete Batched Stepped Wedge Cluster Randomised Trial Design. At least 300 Australian primary schools, from South Australia, Queensland, and Victoria will be recruited and randomised in three batches. Within each batch, schools will be randomly assigned to either start the intervention immediately or start in six weeks. Parents will be recruited from participating schools. The Triple P seminar series includes three seminars titled: "The Power of Positive Parenting", "Helping Your Child to Manage Anxiety", and "Keeping your Child Safe from Bullying". Parents will complete measures about child wellbeing, parenting, parenting self-regulation and other key intervention targets at baseline, six weeks after baseline, and 12 weeks after baseline. Intervention effectiveness will be evaluated with a Multilevel Piecewise Latent Growth Curve Modelling approach. Data collection is currently underway, and the current phase of the project is anticipated to be completed in January 2024. DISCUSSION: The findings from this study will extend the current knowledge of the effects of evidence-based parenting support delivered through brief, universally offered, low intensity, school-based parenting seminars in a post pandemic world. TRIAL REGISTRATION: The trial is registered at the Australian New Zealand Clinical Trials Registry (Trial Registration Number: ACTRN12623000852651).

Psychosocial Resources Predicting Maternal and Paternal Positive Parenting and Lower Child Abuse Risk.

Young children have the highest victimization rates of physical abuse in their first year of life, making up nearly half of all child abuse-related fatalities. More effective prevention is needed to reduce child victimization, yet many risk reduction models rely on problematic inclusion criteria, only intervene after maltreatment has occurred, or focus only on mothers. More proactive prevention models that promote positive parenting practices early in the transition to parenthood could be key to reducing child maltreatment. The current study sought to assess how both mothers' and fathers' psychosocial resources (e.g., emotion regulation, coping, and social support) and empathy can predict positive parenting and predict lower child abuse risk across time in a cross-lagged model. Parenting and abuse risk were examined prenatally, through the transition into parenthood, until children were 4 years old. First time mothers and their partners were recruited in the third trimester of pregnancy and assessed again when children were 6 months, 18 months, and 4 years old. Separate path models for mothers and fathers analyzed whether psychosocial resources and empathy at earlier timepoints predicted their positive parenting and lower abuse risk by the time children were age 4. Findings demonstrated that mothers' earlier empathy predicted later positive parenting and earlier positive parenting predicted later empathy. Fathers' lower prenatal abuse risk predicted greater subsequent empathy. Both mothers' and fathers' psychosocial resources and empathy at earlier timepoints predicted later positive parenting. Parents' psychosocial resources can be integral assets in positive, effective parenting approaches both concurrently and longitudinally. Mothers' and fathers' resources are an important point of intervention prior to and during the transition into parenthood to support healthier families that would confer benefits to child functioning.

Impact of Screening and Co-located Parent Coaching Within Pediatric Primary Care on Child Health Care Use: A Stepped Wedge Design.

Childhood adversity and toxic stress have been associated with poor mental and physical health. This study examined if Parent Connext, a program that integrates adversity screening and parent coaching by co-located specialists within pediatric primary care, had an impact on health care utilization. This stepped wedge cluster randomized controlled trial evaluated Parent Connext across six pediatric primary care practices. All practices (clusters) were in the control period during year 1. Three practices were randomized to begin the Parent Connext intervention in year 2, and three practices were randomized to begin in year 3. Medical records of all patients under age 8 treated at these practices during these 3 years were queried retrospectively for participant-level primary outcomes (sick visits, emergency department visits, hospitalizations) and secondary outcomes (well-child and immunization adherence, referrals). The study sample included 27,419 patients followed for an average 1.39 (SD = 0.66) years in the control period and 1.07 (SD = 0.60) years in the intervention period. During the intervention period, patients had significantly fewer sick visits (IRR = 0.91, p < 0.001) which aligned with our hypothesis, decreased odds of well-child visit adherence (OR = 0.88, p < 0.001) which was unexpected, and increased odds of receiving a referral (OR = 1.45, p < 0.001). The odds of an emergency department visit, hospitalization, and 2-year immunization adherence did not differ between periods. Parent Connext resulted in a significant reduction in child sick visits, highlighting the potential benefit of two-generation approaches to pediatric care for child health.

Mental Health Outcomes Among Parents of Children With a Chronic Disease During the COVID-19 Pandemic: The Role of Parental Burn-Out.

OBJECTIVE: The COVID-19 pandemic and associated quarantine measures highly impacted parental psychological well-being. Parents of children with chronic diseases might be specifically vulnerable as they already face multiple challenges to provide adequate care for their child. The research questions of the current study were twofold: (a) to examine whether parents of children with a chronic disease experienced more anxiety and depression compared to parents of healthy children and (b) to examine a series of risk factors for worsened well-being (i.e., depression, anxiety, and sleep problems), such as sociodemographic variables, COVID-19-specific variables (i.e., financial worries, living space, and perceived quality of health care), and parental psychological experiences (i.e., parental burn-out and less positive parenting experiences). METHODS: Parents of children with a chronic disease (i.e., the clinical sample; N = 599 and 507 for Research Questions 1 and 2, respectively) and parents of healthy children (i.e., the reference sample: N = 417) filled out an online survey. RESULTS: Findings demonstrated that the parents in the clinical sample reported higher levels of anxiety than parents in the reference sample. Analyses within the clinical sample indicated that COVID-19-specific stressors and parental psychological experiences were associated with higher levels of anxiety, depression, and sleep problems. Mediation analyses furthermore indicated that the association of COVID-19-specific stressors with all outcome measures was mediated by parental burn-out. CONCLUSIONS: Parents of children with a chronic disease constitute a vulnerable group for worse well-being during the current pandemic. Findings suggest interventions directly targeting parental burn-out are warranted.

Positive parenting, adolescent adjustment, and quality of adolescent diet in nine countries.

INTRODUCTION: We sought to understand the relation between positive parenting and adolescent diet, whether adolescents' internalizing and externalizing behaviors mediate relations between positive parenting and adolescent diet, and whether the same associations hold for both boys and girls and across cultural groups. METHODS: Adolescents (N = 1334) in 12 cultural groups in nine countries were followed longitudinally from age 12 to 15. We estimated two sets of multiple group structural equation models, one by gender and one by cultural group. RESULTS: Modeling by gender, our findings suggest a direct effect of positive parenting at age 12 on a higher quality diet at age 15 for males (ß = .140; 95% CI: 0.057, 0.229), but an indirect effect of positive parenting at age 12 on a higher quality diet at age 15 by decreasing externalizing behaviors at age 14 for females (ß = .011; 95% CI: 0.002, 0.029). Modeling by cultural group, we found no significant direct effect of positive parenting at age 12 on the quality of adolescent diet at age 15. There was a significant negative effect of positive parenting at age 12 on internalizing (ß = -.065; 95% CI: -0.119, -0.009) and externalizing at age 14 (ß = -.033; 95% CI: -0.086, -0.018). CONCLUSIONS: We founder gender differences in the relations among positive parenting, adolescents' externalizing and internalizing behaviors, and adolescent diet. Our findings indicate that quality of parenting is important not only in promoting adolescent mental health but potentially also in promoting the quality of adolescents' diet.

The Moderating Role of Maternal Praise and Positivity in the Association Between Callous-Unemotional (CU) Traits and Later Aggression: A Prospective Study in Preschool Children in Colombia.

Our previous findings in the UK and Colombia show that CU traits predict later aggression specifically among children who are already aggressive. We hypothesised that this effect would be reduced in the presence of maternal praise and positivity. In a sample of 220 mothers and children from Colombia, mother-child interactions were coded for maternal praise and positivity, and mothers reported on children's CU traits at age 3.5 and aggression at ages 3.5 and 5 years. The results show three-way interactions between CU traits, child aggression and observed parenting at age 3.5 years in the prediction of later child aggression, and two-way interactions indicating a protective effect of positive parenting in the high aggressive children. Based on our finding, it is plausible that positive parenting may modify the effect of CU traits in the highly vulnerable group of children who are already aggressive in early childhood.

Early executive and school functioning: Protective roles of home environment by income.

This study used data from the Family Life Project (N=1,227), a longitudinal study of child development. We tested a three-way interaction in which positive parenting and learning materials in the home from age 6-36 months and family income predicted children's executive functioning (EF) at 58 months. We also tested whether this interaction predicted early school functioning, specifically behavioral and academic skills in the 1st grade. The interactive effects of positive parenting and learning materials differed by family income. For children in families of lower income, more learning materials and positive parenting predicted better EF, and in turn, better early school functioning. For children in families of higher income, only positive parenting significantly predicted EF, which in turn, predicted better early school functioning. Findings suggest that more targeted policy and program support for enrichment and positive parenting may bolster efforts to combat poverty.

Continuity and change in anger and aggressiveness from infancy to childhood: The protective effects of positive parenting.

Early signs of anger and aggression can be identified in infancy. Our aim was to use person-centered methods to identify which infants were most at risk for clinically significant behavioral problems by age 3 and diagnoses of ODD/CD by 7 years, while considering the role of family risk factors and positive parenting. A representative British community sample of 304 infants was assessed by multiple informants at mean ages of 6, 21, and 36 months of age. Latent Transition Analysis (LTA) identified three ordered subgroups at each age, with one subgroup (18%) displaying high levels of physical force as well as anger. These angry aggressive infants were at elevated risk for behavioral problems in early childhood and diagnoses of conduct disorder (CD) and/or oppositional defiant disorder (ODD) at 7 years of age. After other risk factors were taken into account, parents' beliefs in warm parenting and their observed positive affect while interacting with their infants were protective factors. These findings indicate the significance of very early manifestations of angry aggressiveness and have relevance for developmental theories of aggression and prevention strategies.

Feasibility pilot of an adapted parenting program embedded within the Thai public health system.

BACKGROUND: This feasibility pilot of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention content associated with key mechanisms of change perceived by caregivers and facilitators. METHOD: Sixty primary caregivers of children aged 2-9 years were recruited for an 8-week parenting program embedded within the local health system. Mixed-methods approaches included quantitative caregiver-report and observational data from standardized instruments, and qualitative data from individual and group interviews with caregivers and program facilitators. Analyses involved Wilcoxon signed-rank tests, paired t-tests, Friedman's ANOVA, and thematic analysis. RESULTS: Participants reported that most (65%) were grandparents or great-grandparents. Study retention and response rates were high, and enrolled caregivers attended an average of 93% of sessions. Primary outcomes showed caregiver-reported pre-post reductions in overall child maltreatment (d = - 0.58, p < 0.001), as well as reductions in physical (d = - 0.58, p < 0.001) and emotional abuse (d = - 0.40, p < 0.001). Combined caregiver report and observational assessments using the HOME Inventory showed reductions in abusive and harsh parenting (d = - 0.52, p < 0.001). Secondary outcomes demonstrated decreases in child neglect; dysfunctional parenting; poor child monitoring and supervision; parental sense of inefficacy; child behavior problems; daily report on child problem behavior; parent overall depression, anxiety, and stress; and attitudes supporting physical punishment and harsh discipline. There were increases in overall positive parenting, daily positive parenting behavior, as well as HOME Inventory assessments on parent-child relationships. Thematic analyses from interviews and focus group data identified six key program themes associated with strengthened parent-child relationships, reduced child behavior problems, improved attitudes and strategies toward discipline, and improved management of parental stress. CONCLUSIONS: This study represents one of few evaluations to test the feasibility of an evidence-based parenting program embedded within routine public health service delivery in a low- or middle-income country. Findings show preliminary effectiveness in reducing child maltreatment, improvements on 22 of 24 secondary outcomes, and perceived mechanisms of change that support quantitative findings. Prospects are promising for program scalability, pending randomized controlled trial results. TRIAL REGISTRATION: 11/01/2019, ClinicalTrials.gov, ID# NCT03539341 .

"From Analog to Digital": The Feasibility, Acceptability, and Preliminary Outcomes of a Positive Parenting Program for Street-Connected Mothers in Kenya.

BACKGROUND: Children of street-connected women in Kenya are at risk of child maltreatment. There have been increasing calls for positive parenting programs for parents experiencing homelessness, however never has one been implemented with this population. We therefore adapted the evidence-based Parenting for Lifelong Health for Young Children program using participatory methods, and piloted the adapted program with street-connected mothers in Kenya. OBJECTIVES: To (a) determine if the adapted program was feasible and acceptable with street-connected mothers, and (b) assess indicative effects on child maltreatment, positive parenting, and parental stress. PARTICIPANTS AND SETTING: Two groups of 15 mothers (ages 19+, and 20- ) participated between June-July 2018 in Eldoret, Kenya. Participants were eligible if they (a) were the mother of at least one child and (b) self-identified as street-connected. METHODS: Feasibility was measured via enrollment, attendance, drop-out rates, and engagement in take-away activities. Focus groups explored program acceptability and program outcomes. Self-report surveys assessed pre-post changes in child maltreatment, parental stress, parental sense of inefficacy, and positive parenting practices. RESULTS: 70% of participants attended ≥3/4 of sessions, 10% dropped out, and >50% of take-away activities were completed. Participants reported high acceptability and requested its continuation for themselves and other parents. There was an increase in supporting good behaviour (t(21)=8.15, p < .000) and setting limits (t(18) = 10.03, p < .000); a reduction in physical abuse (t(23) = -2.15, p = .042) and parental stress (t(22) = -7.08, p < .000); results for parental inefficacy were not statistically significant (t(22) = 0.15, p = .882). CONCLUSIONS: The adapted program is feasible and acceptable to street-connected mothers, and may reduce child maltreatment and parental stress, and increase positive parenting. Further research should test program effectiveness.

[When ideals put on the pressure]. / Quand les idéaux mettent la pression.

In a society where positive parenting is becoming more and more important, both external and internal pressures on parents are not to be taken lightly. Educational ideals influence the way in which each of us will exercise our parenthood and can lead to risk factors for parental burn-out. Whether in a process of prevention or therapeutic intervention, avenues are envisaged to help parents cope.

Changes in practitioners' attitudes, perceived training needs and self-efficacy over the implementation process of an evidence-based parenting program.

BACKGROUND: Evidence-based family support programs such as the Triple P - Positive Parenting Program have the potential to enhance the well-being of children and families. However, they cannot achieve their expected outcomes if insufficient attention is paid to the implementation process. It has been demonstrated that practitioners' attitudes towards evidence-based programs (EBPs), perceived training needs and self-efficacy for working with parents influence implementation outcomes (e.g., program acceptability, adoption, adherence and sustainability). At the same time, the experience of being involved in the implementation process of an EBP could enhance practitioners' perceptions of the initiative. This study aimed to assess changes in practitioner's attitudes, perceived training needs and self-efficacy over a two-year EBP implementation process, in interaction with their appraisal of their organization's capacity to implement the EPB. METHODS: In the province of Quebec, Canada, Triple P was implemented and evaluated in two communities. Ninety-nine practitioners from various organizations completed questionnaires shortly before their training in Triple P and two years later. RESULTS: Findings show that practitioners who displayed more initial skepticism regarding their organization's capacity to implement the program reported greater improvements in attitudes over time, while practitioners who showed more optimism at baseline reported a greater decrease in their perceived training needs. Practitioners' self-efficacy increased moderately regardless of perceived organizational capacity. CONCLUSIONS: These results are encouraging given that more positive perceptions of EBPs could foster the systematic use of these programs in communities, for the potential benefit of a greater number of families.

Measuring and Predicting Service Providers' Use of an Evidence-Based Parenting Program.

This study addressed the predictors of service providers' use of a multi-level evidence-based program (EBP). Of the 92 trained providers participating in the study, 67 (72.8%) used the EBP at least once. A multidimensional index of the amount of usage (MUI) was created using three indicators. Providers' self-efficacy and the amount of training they had received predicted their amount of usage. The community to which the providers belonged was also associated with their amount of usage. The findings underline the importance of studying many indicators of usage in implementation research and considering both provider-level and broader contextual variables as determinants of the use of EBPs.

[Effects of the Stepping Stones Triple P for mothers of pre-school children with suspected Autistic Spectrum Disorder].

Objective　This study aimed to clarify the effectiveness of the Stepping Stones Triple P (SSTP) for mothers of developmentally delayed children.Methods　The participants were 36 mothers of children using a development support classroom after a medical examination in A city. The children, aged 2 to 6 years old, were suspected to have autism spectrum disorder (ASD) based on Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) scores of 9 points or more. The investigation randomly assigned them to two groups-"the intervention group" and "the control group"-and carried out SSTP. The intervention group answered the questionnaire before and after intervention, three months later. The control group also answered the questionnaire 2 months before the intervention, before and after intervention. Thus, each group answered three times. The questionnaire used the Strengths and Difficulties Questionnaire (SDQ), a Parenting Style scale (PS), the Relationship Quality Index (RQI), and the Japanese version of a Maltreatment scale (JM). For effectiveness of the intervention before and after, an analysis of covariance was carried out on the scores from the first and second questionnaires in the intervention and control groups. For effectiveness 3 months after the intervention, a repeated-measures analysis of variance was performed on the scale scores from the first to the third questionnaire in the intervention group.Results　The average age of the children was 3.7±1.4 years old, and the average PARS score was 20±6.8. They were suspected to have ASD. The average SDQ score was 76.1±18.8, and their intelligence was borderline. A significant difference was seen before and after the intervention in SDQ (the issue of action, the total of the difficulty), PS (overreaction, gab, general score), and JM scores; no significant difference was seen in RQI scores. Three months after the intervention, a lasting effect was seen in SDQ (the issue of action, the total of the difficulty, hyperkinetic) and PS (all items) scores in the intervention group.Conclusions　Receiving SSTP caused a positive change in the mothers' parenting and improved the problem behavior of the children. It was suggested that SSTP was connected to the prevention of child abuse because it helped stop parents from hitting their children.

Effects of harsh parenting and positive parenting practices on youth aggressive behavior: The moderating role of early pubertal timing.

Prior research indicates that early pubertal timing is associated with aggressive behavior, particularly in the context of adversity as postulated in the contextual amplification hypothesis. However, few studies have examined harsh parenting as the context for the effect of early pubertal timing. Even fewer studies have tested the interactive effect of early pubertal timing and positive parenting on aggressive behavior. In this study, we tested the proposition that early pubertal timing, contrary to the general conception of it as a vulnerability, indexed susceptibility, and thus early maturing individuals were affected more by their environment in a "for better and for worse" manner. The sample consisted of 411 community-recruited youth aged 11-12 years (51% boys, 80% African Americans). Participants reported Tanner Stages of pubertal development, aggressive behavior and harsh parenting practice of their parents. Puberty scores were standardized with groups of the same age, sex, and ethnicity, and those that scored the top one-third were defined as early maturing individuals. Parents reported youth's aggressive behavior and their parenting practices towards the youth, including harsh parenting and positive parenting. Early pubertal timing significantly moderated the relationship between harsh/positive parenting and aggressive behavior. Specifically, harsh parenting was positively associated with aggressive behavior to a larger degree among early maturing individuals than among on-time/late-maturing individuals. Positive parenting was inversely associated with aggressive behavior but only among early maturing individuals. This study is the first to document support for early pubertal timing as susceptibility to the environmental influences in relation to aggressive behavior. Theoretical and intervention implications are discussed.

A Pilot of a Brief Positive Parenting Program on Children Newly Diagnosed with Autism Spectrum Disorder.

Disruptive behaviors can be of comparable or greater concern to parents than the core symptoms of Autism Spectrum Disorder (ASD). Provision of effective interventions to address these behaviors within the first year of initial diagnosis holds great potential for improving the child's, parents', and family's functioning. We piloted a four-session, manualized, positive parenting program on 21 parents of newly diagnosed children ages 2 through 12 years using a mixed methods design. Seventy-five percent of parents completed four sessions, with 100% reporting high levels of service satisfaction. Preliminary results indicated clinically and statistically significant reductions in child maladaptive behaviors, as well as improvements in parental and family functioning. Practitioners and parents identified several potential implementation adaptations, including additional sessions to focus on ASD education and real-time parent-child interactions. Taken as a whole, these data suggest that a brief positive parenting intervention may be a feasible way to improve child, parent, and family functioning during the first year of ASD diagnosis. Findings point to the need for additional research to determine treatment efficacy and to assist with the identification of moderators and mediators of effects.

Process Evaluation of the Project SHINE Intervention for African American Families: An Integrated Positive Parenting and Peer Monitoring Approach to Health Promotion.

This study describes the process evaluation of Project SHINE, a randomized family-based health promotion intervention that integrated parenting and peer monitoring for improving sedentary behavior, physical activity, and diet in African American families. Adolescent-parent dyads (n = 89) were randomized to a 6-week behavioral, positive parenting, and peer monitoring skills intervention or a general health education comparison condition. Process evaluation included observational ratings of fidelity, attendance records, psychosocial measures, and qualitative interviews. Results indicated that the intervention was delivered with high fidelity based on facilitator adherence (>98% of content delivered) and competent use of theoretically based behavior change and positive parenting skills (100% of ratings >3 on a 1-4 scale). Although only 43% of peers attended the "bring a friend" session, overall attendance was high (4.39 ± 1.51 sessions) as was the retention rate (88%). Parents in the intervention condition reported significant improvements in communication related to adolescents' engagement in health behaviors both on their own and with peers. These findings were supported by qualitative themes related to improvements in family communication and connectedness. This study provides an innovative example of how future family-based health promotion trials can expand their process evaluation approaches by assessing theoretically relevant positive parenting variables as part of ongoing monitoring.