Research digest: parenting interventions and the role of parental factors and styles in child mental health

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1. Maternal prenatal psychological distress and preschool cognitive functioning: the protective role of positive parental engagement

Julia C. Schechter, Patricia A. Brennan, Alicia K. Smith, Zachary N. Stowe, D. Jeffrey Newport and Katrina C. Johnson

Journal of Abnormal Child Psychology, Springer Link, 2017, Volume 45 (2): 249–260

Considerable animal research and available human studies suggest that psychological distress experienced by mothers during gestation is associated with later neurodevelopmental deficits in offspring; however, little research has examined potential protective factors that might mitigate this risk. The current study examined the impact of maternal prenatal psychological distress during pregnancy on cognitive outcomes in preschoolers (ages 2.5–5 years) and positive parenting as a potential protective factor. Mother-child dyads (N  =  162, mean child age  =  44 months, 49% female) were recruited from a longitudinal cohort of women who had previously participated in a study of maternal mood disorders during pregnancy. Maternal prenatal distress was assessed with multiple measures collected throughout pregnancy. During a follow-up visit, mothers were interviewed about their psychological symptoms since the birth of the child, parenting behaviors were recorded during a parent-child interaction, and children’s cognitive abilities were measured using the Differential Ability Scales, 2nd Edition. Maternal prenatal distress significantly predicted lower general cognitive abilities; however, this relationship was strongest for children whose mothers exhibited low levels of positive engagement and not significant when mothers exhibited high levels of positive engagement. Results suggest that positive parental engagement can protect against the detrimental effects of maternal prenatal distress on preschoolers’ cognitive abilities.

2. Intergenerational continuity of psychological violence: intimate partner relationships and harsh parenting

Tricia K. Neppl, Brenda J. Lohman, Jennifer M. Senia, Shane A. Kavanaugh and Ming Cui

Psychology of Violence, American Psychological Association, 2017, online publication http://dx.doi.org/10.1037/vio0000129

Objective: This prospective, longitudinal investigation examined psychological violence across generations. We examined how parent psychological violence experienced during adolescence influenced the stability of one’s own intimate partner psychological violence perpetration across time and how psychological violence is related to harsh parenting in adulthood. Method: Data came from 193 parents and their adolescent who participated from adolescence through adulthood. Parental psychological violence was assessed in early adolescence. Partner violence was assessed in late adolescence, emerging adulthood, and adulthood. Harsh parenting to their offspring was assessed in adulthood. Results: Parent psychological violence in early adolescence was associated with one’s own intimate partner psychological violence in late adolescence. Partner psychological violence was stable from emerging adulthood to adulthood. Moreover, parental violence was also related to their own harsh parenting in adulthood. Conclusions: Findings suggest that children exposed to parental psychological violence during adolescence may have greater difficulty developing acceptable behaviors in their own romantic relationships over time, as well as parenting their own child in adulthood. Findings highlight the importance for clinicians and policymakers to develop and utilize effective educational and preventive interventions designed toward not only adolescent behaviors, but also that of the parent. Understanding how the family environment impacts current and long-term functioning is important in helping stop the cycle of violence across generations.

(Copyright 2017 APA, all rights reserved)

3. Longitudinal associations between parenting and youth adjustment in twelve cultural groups: cultural normativeness of parenting as a moderator

Jennifer E. Lansford, Jennifer Godwin, Suha M. Al-Hassan, Dario Bacchini, Marc H. Bornstein, Lei Chang, Bin-Bin Chen, Kirby Deater-Deckard, Laura Di Giunta, Kenneth A. Dodge, Patrick S. Malone, Paul Oburu, Concetta Pastorelli, Ann T. Skinner, Emma Sorbring, Laurence Steinberg, Sombat Tapanya, Liane Peña Alampay, Liliana Maria Uribe Tirado and Arnaldo Zelli

Developmental Psychology, American Psychological Association, 2018, Volume 54 (2): 362–377

To examine whether the cultural normativeness of parents’ beliefs and behaviors moderates the links between those beliefs and behaviors and youths’ adjustment, mothers, fathers, and children (N = 1,298 families) from 12 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and the United States) were interviewed when children were, on average, 10 years old and again when children were 12 years old. Multilevel models examined 5 aspects of parenting (expectations regarding family obligations, monitoring, psychological control, behavioral control, warmth/affection) in relation to 5 aspects of youth adjustment (social competence, prosocial behavior, academic achievement, externalizing behavior, internalizing behavior). Interactions between family level and culture-level predictors were tested to examine whether cultural normativeness of parenting behaviors moderated the link between those behaviors and children’s adjustment. More evidence was found for within- than between-culture differences in parenting predictors of youth adjustment. In 7 of the 8 instances in which cultural normativeness was found to moderate the link between parenting and youth adjustment, the link between a particular parenting behavior and youth adjustment was magnified in cultural contexts in which the parenting behavior was more normative.

(Copyright 2018 APA, all rights reserved)

4. What role for parental attributions in parenting interventions for child conduct problems? Advances from research into practice

Vilas Sawrikar and Mark Dadds

Clinical Child and Family Psychology Review, Springer Link, 2018, Volume 21 (1): 41–56

The role of parental attributions in parenting interventions has been the subject of intense interest from clinicians and researchers attempting to optimise outcomes in treatments for children with conduct problems. Despite research articulating the many ways parental attributions can influence behavioural parent training (BPT) outcomes, and recognition that addressing parental attributions in treatment is one of the great challenges faced by BPT practitioners, parenting interventions generally do not provide components that explicitly target or focus on changing problematic parental attributions. In this paper, we ask ‘Should parental attributions be included into best practice interventions? If so, how can this be done in a way that improves outcomes without cluttering and complicating the parent training model?’ We review the theoretical and empirical status of our understanding of the role of parental attributions in BPT with reference to three questions: ‘do pre-treatment parental attributions uniquely predict treatment outcomes’; ‘do changes in parental attributions uniquely predict treatment outcomes’; and ‘does targeting parental attributions in BPT affect treatment outcomes’. Our review indicates that existing research supports the importance of focussing on parental attributions for some families in order to maximise treatment outcomes. However, clinical processes for doing this are yet to be identified and specified in a way that would allow for manualised replication and scrutiny in research designs. We finish with a discussion of how these clinical and research challenges could be approached.

5. Racial discrimination experiences and African American youth adjustment: the role of parenting profiles based on racial socialization and involved-vigilant parenting

Fatima A. Varner, Yang Hou, Tajma Hodzic, Noelle M. Hurd, Sheretta T. Butler-Barnes and Stephanie J. Rowley

Cultural Diversity and Ethnic Minority Psychology, American Psychological Association, 2017,

online publication http://dx.doi.org/10.1037/cdp0000180

Objectives: The purpose of this study was to test whether parenting profiles based on racial socialization and involved-vigilant parenting would compensate for or moderate associations between racial discrimination experiences and academic outcomes and psychological well-being among African American adolescents. Method: Participants were 1,363 African American adolescents (Mage = 14.19; 52.3% female) from 3 Midwestern suburban school districts. Latent profile analysis was used to examine whether there were distinct combinations of parenting. The relationships among racial discrimination experiences, parenting profiles, and adjustment were examined using structural equation modeling (SEM). Results: Three distinct parenting profiles were found: moderate positive (n = 767; moderately high involved-vigilant parenting and racial barrier, racial pride, behavioral, and egalitarian messages, and low negative messages), unengaged (n = 351; low racial socialization messages and moderately low involved-vigilant parenting), and high negative parenting (n = 242; high negative messages, moderate other racial socialization messages, and moderately low involved-vigilant parenting). Racial discrimination experiences were negatively associated with youth adjustment. Moderate positive parenting was related to the best academic outcomes and unengaged parenting was associated with more positive academic outcomes than high negative parenting. Moderate positive parenting was associated with better psychological well-being than unengaged or high negative parenting although the benefits were greater for adolescents with fewer racial discrimination experiences. Conclusions: Distinct patterns of racial socialization messages and involved-vigilant parenting contribute to differences in African American youth adjustment.

(Copyright 2017 APA, all rights reserved)

6. The association between paternal depressogenic cognitive styles during pregnancy and offspring depressogenic cognitive styles: an 18‐year prospective cohort study

Gemma Lewis, Siying Wen, Rebecca M. Pearson and Glyn Lewis

Journal of Child Psychology & Psychiatry, Wiley, 2018, Volume 59 (5): 604–614

Background: Preventing the development of depressogenic or negative cognitive styles could also prevent the development of depression, a leading public health problem worldwide. Maternal negative cognitive styles are a modifiable risk factor for the development of negative cognitive styles in offspring. However, evidence on the role of paternal negative cognitive styles is inconclusive and there have only been a few small studies, which may also have lacked statistical power. Methods: We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to investigate the association between paternal negative cognitive styles, measured when mothers were 18 weeks pregnant, and offspring negative cognitive styles 18 years later (N ≥ 6,123). Associations were calculated using linear regression models, before and after adjustment for confounders including maternal negative cognitive styles. We compared associations before and after controlling for depression in parents and offspring, and used multiple imputation to reduce biases that may have arisen due to missing data. Results: A two‐standard deviation increase in paternal negative cognitive style was associated with a 3‐point increase in offspring negative cognitive style (95% CI 1.36–4.37). This association remained after adjustment for confounders and was independent of depression in both parents and offspring. The effect size was equivalent to that of maternal negative cognitive style, and was also independent of maternal negative cognitive style. Conclusions: Our results suggest that fathers should be included in individual‐ and family‐based interventions designed to prevent the development of depressogenic cognitive styles in adolescent offspring. This could possibly also prevent the development of depression.

7. The mitigating effects of maternal social support and paternal involvement on the intergenerational transmission of violence

Melissa Tracy, Madeleine Salo and Allison Appleton

Child Abuse & Neglect, Elsevier, 2018, Volume 78: 46–59

Childhood maltreatment is a strong risk factor for subsequent violence, including violent behaviors in young adulthood and offspring maltreatment after becoming a parent. Little is known about the specific circumstances under which supportive relationships may help disrupt this cycle of violence throughout the life course. We conducted two complementary analyses to assess whether maternal social support in early childhood, and also paternal involvement in middle childhood, could prevent the intergenerational transmission of violence, using data from the Avon Longitudinal Study of Parents and Children (n = 11,384). We found that higher levels of maternal social support in the postpartum period reduced the odds of offspring maltreatment at ages 0–8 years (OR = 0.95, 95% CI 0.93–0.96). When classifying mothers according to their abuse history, this protective association of social support was observed among mothers with no history of childhood maltreatment and among those with only childhood maltreatment (and not postpartum intimate partner violence [IPV]), but not among mothers who reported IPV since the child’s birth. We then extended our analysis of these offspring forward in time and found that paternal involvement at ages 9–10 years was associated with a reduced risk of offspring self-reported violent perpetration at ages 18–20 years (OR = 0.85, 95% CI = 0.77–0.94). This protective association was generally apparent among all subgroups of children, including those with a history of childhood maltreatment. Together these results highlight the protective influence of supportive relationships against the intergenerational transmission of violence, depending on abuse history, context, and timing, with important implications for the prevention of childhood maltreatment and mitigation of its negative effects.

8. Parental depressive symptoms as a predictor of outcome in the treatment of child depression

Dikla Eckshtain, Lauren Krumholtz Marchette, Jessica Schleider and John R. Weisz

Journal of Abnormal Child Psychology, Springer Link, 2018, Volume 46 (4): 825–837

Child depression is an impairing condition for which psychotherapies have shown modest effects. Parental depression is a risk factor for development of child depression and might also be negatively associated with child depression treatment outcomes. To explore this possibility, we analyzed data from a study in which children were treated for depression after parental depressive symptoms had been assessed at baseline. Among children treated for depression in a randomized controlled trial, we identified 31 who had child- and parent-report pre- and post-treatment data on child symptoms and parent-report of pre-treatment parental depressive symptoms. Children were aged 8–13, 77% boys, and 52% Caucasian, 13% African-American, 6% Latino, and 29% multi-racial. Analyses focused on differences in trajectories of change (across weekly measurements), and post-treatment symptoms among children whose parents did (n = 12) versus did not (n = 19) have elevated depressive symptoms at baseline. Growth curve analyses showed markedly different trajectories of change for the two groups, by both child-report (p = 0.03) and parent-report (p = 0.03) measures: children of parents with less severe depression showed steep symptom declines, but children of parents with more severe depression showed flat trajectories with little change in symptoms over time. ANCOVAs showed lower post-treatment child symptoms for children of parents with less severe depression versus parents with more severe depression (p = 0.05 by child report, p = 0.01 by parent report). Parental depressive symptoms predict child symptom trajectories and poorer child treatment response, and may need to be addressed in treatment.

9. Parenting and child mental health

Rachael Ryan, Christine O’Farrelly and Paul Ramchandani

London Journal of Primary Care, Taylor and Francis, 2017, Volume 9 (6): 86–94

This paper reviews parenting programmes and their effectiveness with families of young children and highlights additional resources for primary care practitioners. Typically, 30% of GP consultations concern child behaviour problems and established behaviour problems can have lasting effects on children’s life chances. These problems can be identified in infancy and toddlerhood. Parenting is a key risk factor in their development and maintenance, yet is also amenable to change. In this paper we consider six parenting programmes that are widely evaluated and/or available in the U.K. and their evidence base . These include two NICE recommended parenting programmes (Incredible Years and Triple P), which offer tiered and flexible parenting programmes; predominantly for parents of school-age children. We also review Parent–Infant Psychotherapy, which is typically for parents of younger children. Fourth is Family Nurse Partnership, an intensive programme to support young, first-time mothers. Finally we consider, video feedback programmes which use video to focus in detail on parents’ interactions with their children, including Video Feedback to Promote Positive Parenting and Video Interactive Guidance. These interventions demonstrate the range of approaches which are being used to intervene early in children’s lives to try to prevent the development of enduring behavioural problems.

10. Improving mental health outcomes of Burmese migrant and displaced children in Thailand: a community-based randomized controlled trial of a parenting and family skills intervention

Jeannie Annan, Amanda Sim, Eve S. Puffer, Carmel Salhi and Theresa S. Betancourt

Prevention Science, Springer Link, 2017, Volume 18 (7): 793–803

The negative effects of displacement and poverty on child mental health are well-known, yet research on prevention interventions in low- and middle-income countries, especially fragile states, remains limited. We examined the effectiveness of a parenting skills intervention on mental health outcomes among Burmese migrant and displaced children living in 20 communities in Thailand. Participants were primary caregivers and children aged 7 to 15 years (n  =  479 families). Families were randomly assigned to receive an adapted version of the Strengthening Families Program (n  =  240) or a wait-list control condition (n  =  239). Assessments were conducted at baseline and 1-month post-intervention for both conditions and at 6 months for treatment group only. One month after the program, children in the treatment condition showed significant reductions in externalizing problems (caregiver effect size (ES) −0.22, p  =  0.02; child report ES −0.11, p  =  0.02) and child attention problems compared with controls (caregiver report ES −0.23, p  =  0.03). There was no significant treatment effect on children’s internalizing problems (ES −0.06; p  =  0.31). Children reported a significant increase in prosocial protective factors relative to controls (ES 0.20, p < 0.01). Results suggest that an evidence-based parenting skills intervention adapted for a displaced and migrant Burmese population facing high levels of adversity can have positive effects on children’s externalizing symptoms and protective psychosocial factors.

11. Mindful parenting in mental health care: effects on parental and child psychopathology, parental stress, parenting, coparenting, and marital functioning

Susan M. Bögels, Joke Hellemans, Saskia van Deursen, Marieke Römer and Rachel van der Meulen

Mindfulness, Springer Link, 2014, Volume 5 (5): 536–551

This study evaluated the acceptability and effects of a Mindful Parenting course in mental health care. Parents (n  =  86) referred to secondary mental health care because of their children’s and/or their own psychopathology, or parent–child relationship problems, followed a Mindful Parenting course in a group format (10 groups). Assessments took place just before the course (pre-test), immediately after the nine-week course (post-test), and at 8-week follow-up. A waitlist assessment took place only for those parents who had to wait for a course (n  =  23). Measures concerned parent report of psychopathology symptoms of their target child, as well as their own psychopathology symptoms, parental stress, parenting behaviors, coparenting, and marital functioning. Only one parent dropped out and parents evaluated the program as valuable and effective in many areas of family functioning. No improvement was reported during waitlist, except for an improvement in parental externalizing symptoms. Improvements after the course occurred in the target child’s internalizing and externalizing psychopathology symptoms, parents’ own internalizing symptoms and further improvement on their externalizing symptoms. Also, improvements occurred on parental stress, parenting, and coparenting, but not on marital functioning. Improvements were generally maintained at follow-up. In conclusion, the very low dropout rate as well as the positive evaluations, suggest that Mindful Parenting is an acceptable and feasible intervention in mental health care. Mindful Parenting appears a promising new intervention for parents in mental health care, as it seems effective on a broad range of child, parent, and family variables. Studies comparing Mindful Parenting to other effective interventions, such as Parent Management training, are needed to gain more knowledge about its relative and differential effectiveness.

12. Mothers, fathers, and parental systems: a conceptual model of parental engagement in programmes for child mental health – Connect, Attend, Participate, Enact (CAPE)

Patrycja J. Piotrowska, L. A. Tully, R. Lenroot, E. Kimonis, D. Hawes, C. Moul, P. J. Frick, V. Anderson and M. R. Dadds

Clinical Child and Family Psychology Review, Springer Link, 2017, Volume 20 (2): 146–161

Parenting programmes are one of the best researched and most effective interventions for reducing child mental health problems. The success of such programmes, however, is largely dependent on their reach and parental engagement. Rates of parental enrolment and attendance are highly variable, and in many cases very low; this is especially true of father involvement in parenting programmes. This paper proposes a conceptual model of parental engagement in parenting programmes – the CAPE model (Connect, Attend, Participate, Enact) that builds on recent models by elaborating on the interdependent stages of engagement, and its interparental or systemic context. That is, we argue that a comprehensive model of parental engagement will best entail a process from connection to enactment of learned strategies in the child’s environment, and involve consideration of individual parents (both mothers and fathers) as well as the dynamics of the parenting team. The model provides a framework for considering parent engagement as well as associated facilitators and mechanisms of parenting change such as parenting skills, self-efficacy, attributions, and the implementation context. Empirical investigation of the CAPE model could be used to further our understanding of parental engagement, its importance for programme outcomes, and mechanisms of change. This will guide future intervention refinement and developments as well as change in clinical practice.

13. ‘And when you were a child?’: how therapists working with parents alongside child psychotherapy bring the past into their work

Claire Whitefield and Nick Midgley

Journal of Child Psychotherapy, Taylor and Francis, 2015, Volume 41 (3): 272–292

When a child is offered psychotherapy, it is common that regular meetings will be offered to the parents. However, there are debates in the literature about the degree to which such parent work should include a focus on the parents’ own childhood experiences. This study aimed to examine the way that those offering parent work as part of a study evaluating the treatment of adolescent depression dealt with this issue in their work with parents, both in the study and in routine clinical practice. Design: five therapists were interviewed on the subject of working with parents’ childhood experiences within parent work parallel to child psychotherapy. Data were analysed qualitatively, using Interpretative Phenomenological Analysis. Findings: participants described the need to consider the different parameters of this work to individual adult therapy; in addition, participants felt that it was necessary to negotiate permission to work on the parents’ childhood experiences. They also spoke of making use of insight into the repetition of the parents’ history, the analysis of parental projections and offering containment within the relationship; this varies from the ‘transference work’ of individual therapy and a different style of interpretation was described. Conclusions: there is a need to give more attention to the neglected field of working with parents alongside individual child psychotherapy, especially at a time when such work is under threat within many public services. There are particular technical issues related to work with parents’ own childhood histories that are different to how one might work in individual therapy with a parent.

14. Parental involvement in adolescent depression interventions: a systematic review of randomized clinical trials

Latefa Dardas, Brittney van de Water and Leigh Ann Simmons

International Journal of Mental Health Nursing, Wiley, 2018, Volume 27 (2): 555–570

Despite the widespread research recommendations for psychiatric nurses and other mental health professionals to include parents in adolescent depression treatment, no systematic reviews have yet synthesized the findings from intervention studies that included parents in the treatment and/or prevention of adolescent depression. Therefore, this systematic review was conducted to (i) identify and describe clinical trials that included parents as an integral component of adolescent depression interventions, (ii) examine the effectiveness of these trials in reducing depressive symptoms, and (iii) evaluate their methodological quality. We systematically searched the databases PubMed and PsycINFO. The search strategy adhered to the PRISMA statement to guide identification and selection of articles. Further, a structured evaluation form was adapted from the CONSORT statement and methodological literature to evaluate the elicited clinical trials. A total of 288 unique articles met criteria for abstract level screening, 45 articles were selected for full‐text review, and 16 articles were included in the final analysis. We found that (i) available approaches to include parents in adolescent depression interventions vary in their theoretical stance, purpose, sample characteristics, and measured outcomes, (ii) the health outcomes of these approaches seemed to be contingent upon the nature of parental involvement, and (iii) effective translation of these approaches into practice needs to be considered in the light of their methodological rigour. Our review revealed a variety of promising approaches to utilize the parental and family contexts as a means of preventing or treating adolescent depression. However, more research is needed to determine which interventions, within what contexts, and using what resources will facilitate the best health outcomes for adolescents with depression and their parents.