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Improvements in negative parenting mediate changes in children's autonomic responding following a preschool intervention for ADHD


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Abnormal patterns of sympathetic- and parasympathetic- linked cardiac activity and reactivity are observed among externalizing children, and mark deficiencies in central nervous system regulation of behavior and emotion. Although changes in these biomarkers have been observed following treatment, mechanisms remain unexplored. We used MEMORE—a new approach to analyzing intervening variable effects—to evaluate improvements in parenting as mediators of changes in SNS- and PNS-linked cardiac activity and reactivity among 99 preschoolers with attention-deficit hyperactivity disorder who were treated using an empirically supported intervention. Decreases in negative parenting (criticism, negative commands, physical intrusions) were associated with increases in resting RSA and PEP reactivity to incentives from pre- to post-intervention. Increases in positive parenting were not associated with changes in autonomic function. These findings suggest socially-induced plasticity in peripheral biomarkers of behavior and emotion regulation, and underscore the importance of reducing aversive interactions between parents and children when treating externalizing behavior.
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DOI: 10.1177/2167702617727559
Empirical Article
Over the past 40 years, extensive research has eluci-
dated socialization mechanisms through which
emotional lability and emotion dysregulation are shaped
and maintained in families of children with externalizing
behavior disorders (Patterson, DeGarmo, & Knutson,
2000; Snyder, 1977; Snyder, Edwards, McGraw, Kilgore,
& Holton, 1994). In many such families, dyad members
escalate conflict because doing so effectively terminates
aversive interactions. Such coercive exchanges occur
thousands of times across development and negatively
reinforce conflict escalation and associated emotional
liability, since escape from highly aversive interactions
provides relief (Beauchaine & Zalewski, 2016; Snyder,
Schrepferman, & St. Peter, 1997).
Historically, research on family dynamics has been
conducted at the behavioral level of analysis through
painstaking coding of dyadic interactions. This research
demonstrates that operant reinforcement is at play in
the development of coercive relationships (Snyder,
1977; Snyder etal., 1994). More recent findings suggest
that negative reinforcement of emotional lability also
shapes and maintains patterns of physiological activity
and reactivity that often characterize individuals with
impulse control and emotion dysregulation problems
(see Beauchaine, 2015a; Beauchaine, Gatzke-Kopp, &
Mead, 2007; Beauchaine & Zalewski, 2016; Crowell
etal., 2017).
727559CPXXXX10.1177/2167702617727559Bell et al.Effects of Parenting on Children’s Autonomic Function
Corresponding Author:
Theodore P. Beauchaine, Department of Psychology, The Ohio State
University, 1835 Neil Avenue, Columbus, OH 43210
Improvements in Negative Parenting
Mediate Changes in Children’s Autonomic
Responding Following a Preschool
Intervention for ADHD
Ziv Bell1, Tiffany Shader1, Carolyn Webster-Stratton2,
M. Jamila Reid3, and Theodore P. Beauchaine1
1The Ohio State University; 2University of Washington; and 3Incredible Years, Seattle, Washington
Abnormal patterns of sympathetic- and parasympathetic-linked cardiac activity and reactivity are observed among
externalizing children and mark deficiencies in central nervous system regulation of behavior and emotion. Although
changes in these biomarkers have been observed following treatment, mechanisms remain unexplored. We used
MEMORE—a new approach to analyzing intervening variable effects—to evaluate improvements in parenting as
mediators of changes in sympathetic nervous system (SNS)- and parasympathetic nervous system (PNS)-linked cardiac
activity and reactivity among 99 preschoolers with attention-deficit hyperactivity disorder who were treated using
an empirically supported intervention. Decreases in negative parenting (criticism, negative commands, physical
intrusions) were associated with increases in resting respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP)
reactivity to incentives from pre- to postintervention. Increases in positive parenting were not associated with changes
in autonomic function. These findings suggest socially induced plasticity in peripheral biomarkers of behavior and
emotion regulation and underscore the importance of reducing aversive interactions between parents and children
when treating externalizing behavior.
RSA, HRV, PEP, ADHD, externalizing, parenting, intervention, mediation
Received 1/27/17; Revision accepted 7/13/17
2 Bell et al.
Family Dynamics and Parasympathetic
Nervous System (PNS) Function
Respiratory sinus arrhythmia (RSA), defined by periodic
increases and decreases in heart rate across successive
respiratory cycles, is both a peripheral index of PNS
efference to the heart and a useful biomarker of emo-
tion regulation capabilities, given appropriate stimulus
conditions (see, e.g., Beauchaine, 2001, 2015a, 2015b;
Beauchaine & Thayer, 2015; Porges, 2007). As reviewed
elsewhere (e.g., Shader et al., in press; Zisner &
Beauchaine, 2016), a large literature demonstrates asso-
ciations between RSA reactivity and emotion regulation
specifically during emotion evocation tasks but not dur-
ing tasks that assess other abilities such as attention
Children, adolescents, and adults who experience
problems with emotion dysregulation often exhibit low
resting RSA and/or excessive RSA reactivity (PNS with-
drawal) to emotionally evocative stimuli (see
Beauchaine, 2015a, 2015b; Beauchaine & Thayer, 2015;
Crowell etal., 2005). Perhaps unsurprisingly given that
emotion dysregulation is a hallmark of externalizing
psychopathology, low resting RSA and excessive RSA
reactivity are also observed among children and ado-
lescents with conduct problems, delinquency, and asso-
ciated mental health conditions (e.g., Beauchaine,
Katkin, Strassberg, & Snarr, 2001, Beauchaine etal,
2007, 2013; de Wied, van Boxtel, Matthys, & Meeus,
2012). Such deficiencies in PNS-linked cardiac function
among children with externalizing behavior problems
are observed as early as the preschool years (Crowell
etal., 2006) and predict responses to empirically sup-
ported interventions (Beauchaine etal., 2013). Accord-
ing to contemporary transactional models, emotion
dysregulation and its physiological substrates are
shaped and maintained among children at least in part
through negative reinforcement mechanisms, as out-
lined above (Beauchaine etal., 2007; Beauchaine &
Zalewski, 2016). This assertion is supported empirically
among families of children with multiple adjustment
problems (e.g., Crowell etal., 2013, 2014, 2017; Skowron
etal., 2011).
Externalizing Psychopathology and
Sympathetic Nervous System (SNS)
From preschool to adolescence, children with external-
izing disorders also demonstrate compromised SNS-
linked cardiac activity and reactivity (Beauchaine etal.,
2001, 2013, 2015; Crowell etal., 2006). Cardiac pre-
ejection period (PEP), quantified by the time between
left ventricular depolarization and ejection of blood into
the aorta, marks SNS reactivity via β-adrenergic mecha-
nisms (Sherwood etal., 1990). In a series of papers, we
have argued that PEP nonreactivity to monetary incen-
tives marks central nervous system reward dysfunction,
which confers vulnerability to a range of externalizing
disorders (e.g., Beauchaine etal., 2013). Consistent with
this perspective, lengthened PEP at rest and reduced
PEP reactivity to incentives are observed among
children with ADHD and children with conduct disor-
der and predict early initiation of alcohol and substance
use (Beauchaine et al., 2001, 2013; Brenner &
Beauchaine, 2011; Crowell etal., 2006). Moreover, defi-
ciencies in PEP and RSA interact to predict especially
poor outcomes among children with externalizing
behavior problems (see Beauchaine etal., 2007; Pang
& Beauchaine, 2013).
Transactional models of externalizing behavior sug-
gest that for some, neurobiological vulnerabilities inter-
act with environmental risk to promote increasingly
intractable comportment outcomes across development
(see Beauchaine & McNulty, 2013; Beauchaine, Zisner,
& Sauder, 2017). Impulsive children, many of whom
exhibit the autonomic characteristics described above,
may be particularly vulnerable to developing severe
externalizing behavior when exposed to environmental
adversity, including coercive family processes. In this
article, we evaluate (1) whether deficiencies in SNS-
and PNS-linked cardiac activity/reactivity improve dur-
ing treatment for externalizing behavior and (2) whether
any such improvement is mediated by changes in par-
enting. Such findings would be consistent with research
outlined above suggesting that parenting—specifically
negative reinforcement of emotional lability—shapes
and maintains children’s physiological response pat-
terns (Beauchaine & Zalewski, 2016; Beauchaine etal.,
2007; Crowell etal., 2017). Although the notion that
short-term interventions might alter children’s psycho-
physiological function may seem implausible, such
effects on other psychophysiological measures, includ-
ing electrodermal responding, have been observed
(e.g., Beauchaine etal., 2015; Raine etal., 2001).
Treating Externalizing Behaviors
Empirically supported psychosocial treatments for
externalizing behaviors almost invariably include com-
ponents that target coercive parenting (see, e.g., Eyberg,
Nelson, & Boggs, 2008; Pelham & Fabiano, 2008). The
Incredible Years® (IY) intervention is a well-established
treatment for conduct problems among children ages
4 to 12 years (see Beauchaine, Webster-Stratton, & Reid,
2005; Webster-Stratton, 2015). The program includes
parent, child, and teacher components. Parents meet in
small-group sessions, during which trained therapists
Effects of Parenting on Children’s Autonomic Function 3
discuss adaptive responses to children’s impulsive and
dysregulated behaviors. Parents also watch vignettes of
behaviors that are typical of children with externalizing
psychopathology and learn to issue clear, age-
appropriate commands, avoid conflict escalation, and
positively reinforce socially competent behaviors and
emotion regulation. Child components include struc-
tured and unstructured group activities with trained
therapists who teach anger management, emotional
awareness, emotion regulation, and appropriate social
behaviors. Together, parent and child components
decrease coercion within families, teach prosocial
skills to children, reduce conduct problems, and
improve emotion regulation (Webster-Stratton, Reid, &
Beauchaine, 2011). A randomized, waitlist control trial
of IY conducted by our research group among pre-
school children produced pre-post treatment improve-
ments in child externalizing behavior, child emotion
regulation, self-report parenting behaviors, and
observed positive parenting (Beauchaine etal., 2013;
Webster-Stratton etal., 2011; Webster-Stratton, Reid, &
Beauchaine, 2013). Reductions in negative parenting
during both home visits and lab sessions were also
observed. Moreover, treated children exhibited pre–
post improvements in electrodermal responding
(Beauchaine etal., 2015).
In this study, we evaluate changes in positive and
negative parenting as mediators of changes in SNS- and
PNS-linked cardiac activity and reactivity following
treatment for ADHD. Although few studies have
addressed such questions, Graziano, Bagner, Sheinkopf,
Vohr, and Lester (2012) found that improvements in
parenting following treatment for behavior problems
predicted changes in RSA reactivity among children
born prematurely. However, children in their study
were younger and had fewer behavior problems. More-
over, they did not assess changes in SNS-linked cardiac
Toward evaluating changes in parenting as mediators
of changes in children’s autonomic function, we apply
the well-established Kraemer, Wilson, Fairburn, and
Agras (2002) conceptual criteria for evaluating interven-
ing variable effects. We test these effects statistically
using MEMORE (Montoya & Hayes, 2016), a new
method that uses bootstrap confidence intervals to test
direct and indirect effects of mediation, as described in
further detail below.
Data were collected as part of a randomized controlled
trial of the IY intervention (Webster-Stratton etal., 2011,
2013). Preschool-aged children (n = 99), ages 4 to 6
years (mean age = 5.36, SD = 0.92), with the hyperac-
tive/impulsive or combined subtypes of ADHD, based
on Diagnostic and Statistical Manual for Mental Disor-
ders (4th ed., text rev.; DSM-IV-TR; American Psychiatric
Association, 2000) criteria, were recruited. Participant
children were 76% male, and 22% identified as ethnic
minority, consistent with the Seattle population. The
inattentive subtype was excluded, since it is distinct
etiologically from the hyperactive/impulsive and com-
bined subtypes (Adams, Derefinko, Milich, & Fillmore,
2008; Fair etal., 2013) and does not portend progres-
sion to more severe externalizing behaviors in later
childhood and adulthood (e.g., Beauchaine, Ben-David,
& Sela, 2017; Diamond, 2005; Lee, Burns, Becker, &
Beauchaine, 2016).
Families were recruited through print advertisements
placed in local publications and posted at schools and
pediatricians’ offices. Parents were invited to complete
an initial phone interview if their child was ever diag-
nosed with ADHD. Trained research assistants com-
pleted phone interviews with 204 families and explained
study procedures and inclusion criteria. Parents of chil-
dren who still appeared to be eligible then completed
the attention problems subscale of the Child Behavior
Checklist (Achenbach & Edelbrock, 1991) and the
hyperactive/impulsive and combined ADHD scales of
the Child Symptom Inventory (CSI; Gadow & Sprafkin,
1997). Those who appeared to meet DSM-IV criteria for
ADHD on the CSI and scored at or above the 95th
percentile on the attention problems subscale of the
CBCL were invited to the lab for an interview using the
Diagnostic Interview Schedule for Children (DISC;
Shaffer, Fisher, Lucas, Mina, & Schwab-Stone, 2000).
Among 103 families who visited the lab, 99 had a child
with ADHD and were enrolled in the study.
All study procedures were approved by the local insti-
tutional review board. Families were randomized to
immediate (n = 49) and delayed (waitlist control) inter-
vention (n = 50) groups. Children in the immediate
intervention participated with one or both parents in
twenty 2-hr weekly sessions beginning after pretreat-
ment assessment of behavioral and psychophysiological
measures in which parents and children met in separate
groups (see Webster-Stratton etal., 2011). As outlined
above, parents learned effective problem-solving, adap-
tive emotion regulation, positive parenting techniques,
and effective parenting responses to impulsive/
disruptive child behaviors, among other topics. Children
participated in the IY Dinosaur training program, in
which trained therapists taught and coached emotion
4 Bell et al.
regulation skills during structured and unstructured
activities. Therapists reinforced topics related to emo-
tional awareness, anger management, teamwork, and
Families in the delayed intervention group started
treatment following postassessments of immediate
intervention participants, approximately 20 weeks after
pretreatment assessments. Parents in the delayed condi-
tion received 10 sessions of IY parenting groups—half
the dose of the immediate intervention condition. Chil-
dren in the delayed condition received an equivalent
dose of the IY Dinosaur program as those in the imme-
diate intervention (approximately 40 hr). In this study,
we combine participants into a single group for all
analyses. This was necessary to attain an adequate
sample size to address our main hypotheses, which
required tests of statistical interactions (see below).
Combining groups is justified in part given nonsignifi-
cant group differences on all but 10 of 136 parent and
child behavioral outcome measures (about the number
expected by chance; see Beauchaine etal., 2015). More
importantly, the average effect size of these 136 group
comparisons was quite small (d = 0.04).
Interventions were delivered by master’s- and doc-
toral-level therapists who were certified to lead IY
groups. Details about adherence and fidelity are
reported elsewhere (Webster-Stratton etal., 2011, 2013).
Pretreatment assessments for all participants (both the
immediate and delayed conditions) were completed
approximately 1 week after the diagnostic interviews,
prior to the start of IY for the immediate condition.
Posttreatment assessments were completed separately
at the end of treatment for each condition.
Laboratory tasks
Psychophysiological measures were collected during the
pretreatment assessment in 30-min laboratory sessions.
Children participated in a protocol that began with a
resting 5-min baseline in a noise-attenuated, distraction-
free room. To evaluate incentive responding, children
played a matching game to earn toy rewards, similar to
tasks previously used to assess responses to reward in
preschool children (Crowell etal., 2006). In this game,
they are presented with shapes (e.g., circles, squares,
triangles) on a computer screen and select matching
shapes on an age-appropriate keyboard. Correct
responses are paired with an image of a smiley face and
a tone, whereas incorrect responses are paired with a
blank screen and a different tone. Children are told that
if they collect enough smiley faces, they can choose
from a container of toys, all worth about $10. Following
the task, children are allowed to keep a toy for “trying
hard,” regardless of their performance.
Next, children and their parent (mothers in all but
one case) engaged in 7 min of free play, followed by
a 2-min rest period, then a frustrating block building
task. During the task, children were tethered to psy-
chophysiological recording equipment and sat within
a small marked area on the floor to reduce movement-
related artifacts. Parents were instructed to retrieve and
dump a container of large foam blocks on the floor.
Without touching the blocks, parents coached their
children to build progressively complex structures
based on figures given to the parent. The task is difficult
for 4 to 6-year-olds and is frustrating for both parents
and children, as assessed by observations of dyadic
conflict and expressions of negative affect (Beauchaine,
Strassberg, Kees, & Drabick, 2002).
Psychophysiological measures
RSA. High-frequency spectral densities were calculated
via fast Fourier transformation of R-R time series in
Kubios 2.2 (Tarvainen, Niskanen, Lipponen, Ranta-Aho,
& Karjalainen, 2014). Electrocardiographic (ECG) signals
were sampled at 1 kHz by an HIC 2004 impedance car-
diograph, using a spot electrode configuration (Qu,
Zhang, Webster, & Tompkins, 1986). Accurate assess-
ment of RSA requires appropriate specification of respira-
tory frequencies (Ritz, 2009; Shader etal., 2017), which
vary considerably by age (see Zisner & Beauchaine,
2016). We therefore used FFT windows that were adjusted
for ages of participants, based on published population
values (Fleming et al., 2011; Wallis, Healy, Undy, &
Maconochie, 2005). FFT windows were set to 0.33 to 0.50
Hz for 4-year-olds, 0.32 to 0.50 Hz for 5-year-olds, and
0.30 to 0.50 Hz for 6-year-olds. Of note, negligible
respiratory-linked spectral power is observed above 0.50
Hz, regardless of age (see Shader etal., 2017). Resting
RSA was calculated across the final 1 minute of the initial
5-minute baseline, whereas RSA reactivity to emotion
evocation was calculated by subtracting resting RSA col-
lected during the 2-minute baseline immediately before
the block task from RSA collected during block building.
Thus, as is customary in psychophysiological research,
negative scores indicate RSA withdrawal (reduced PNS
PEP. The HIC 2004 impedance cardiograph was used to
collect both ECG and impedancecardiographic (ICG)
waveforms. Cardiac data were segmented into 30-second
epochs using Bio-Impedance Technology CopWin soft-
ware, version 5.06 (Bio-Impedance Technology, Inc., 2001).
PEP values were ensemble-averaged in 30-second epochs
by trained research assistants, who inspected all data visu-
ally to ensure proper placement of the dZ/dt B-wave. Reac-
tivity was calculated by subtracting ensemble-averaged PEP
Effects of Parenting on Children’s Autonomic Function 5
values during the final 1 min of the initial 5-min resting
baseline from those collected during the incentive task. As
is customary, negative values therefore indicate PEP short-
ening (increased SNS activity).
Complete psychophysiological data were available
for 81% of children, and complete behavioral observa-
tion data (see below) were available for 85% of parents.
Nine participant children did not return for the post-
treatment clinic visit, and data from 11 participants were
affected by excessive movement or problems with
physiological recording. In addition, 15 participant
families did not complete the posttreatment home visit.
Missing data were replaced by averaging across 30
imputations following recommendations set forth by
Graham (2009).
Behavior observations
Behavior observations were conducted during 30-min
free play sessions in participants’ homes. Parents and
children were instructed to stay in one room with famil-
iar toys and not to use electronics such as televisions
or handheld gaming devices. Trained research assistants
who were blind to condition and study hypotheses
coded child and parent behaviors from videotapes of
these sessions, using the Dyadic Parent-Child Interac-
tion Coding System (DPICS; Robinson & Eyberg, 1981).
The DPICS is a well-researched microanalytic coding
system that assesses parenting behaviors including
positive affect, critical statements, encouragement, and
negative physicality. For purposes of this study, two
parenting composites were formed, including positive/
supportive parenting and negative/critical parenting.
Scores on these behaviors were summed across the
entire 30 min. Following from Reid, Webster-Stratton,
and Hammond (2007), positive parenting included
positive affect, positive physicality, praise, descriptive
commenting, encouragement, and problem-solving.
Negative parenting included critical statements, nega-
tive commands, commands with no opportunity for
compliance, physical intrusions, and negative physical-
ity. We have used these composite variables in several
previous studies (e.g., Reid etal., 2007). Mothers who
participate in the IY program use more positive parent-
ing and less negative parenting than untreated controls.
Although these changes are associated with improve-
ments in child behavior and dyadic relationship quality
(e.g., Webster-Stratton etal., 2011, 2013), no previous
research has evaluated relations between treatment-
induced changes in parenting in the home and chil-
dren’s physiological reactivity.
Pre-post changes in
parenting, externalizing, and
psychophysiological responding
Postintervention child outcomes, including mother,
father, and teacher reports, are presented elsewhere
(Beauchaine etal., 2013, 2015; Webster-Stratton etal.,
2011, 2013) and are summarized in Table 1. In brief,
mothers, fathers, and teachers all reported significant
reductions in children’s externalizing behaviors, includ-
ing impulsivity, hyperactivity, and oppositionality. In
addition, behavior observations indicated improve-
ments in social competence. From pre- to postinterven-
tion, children’s resting RSA increased, as did their RSA
reactivity. Changes in PEP activity and reactivity were
not found. Since sample-wide changes in dependent
variables are not prerequisites for mediation, analyses
were conducted as planned (see below).
As noted above, differences in children’s behavioral
outcomes between the immediate and delayed condi-
tions were negligible. Furthermore, changes in their
physiological responding did not differ across condi-
tions, all ts(97) 1.48, all ps .142, all ds 0.30. In
contrast, greater improvements in both positive and
Table 1. Descriptive Statistics for Child Outcomes
Variable Pre mean (SD) Post mean (SD)t(98) p d
CBCL externalizing (T) 64.6 (8.8) 58.3 (1.3) 6.53 < .001 1.32
CPRS-R hyperactivity (T) 74.5 (8.7) 63.8 (15.4) 6.63 < .001 1.34
CPRS-R oppositionality (T) 67.7 (12.0) 59.0 (14.7) 5.03 < .001 1.02
Resting RSA (ln[ms2]) 5.49 (1.15) 5.87 (1.16) 2.75 .007 0.56
RSA reactivity (ln[ms2]) −0.38 (0.95) −0.75 (1.24) −2.37 .020 −0.48
Resting PEP (ms) 80.55 (12.49) 79.35 (11.87) −0.90 .373 −0.10
PEP reactivity (ms) 1.05 (3.76) 1.05 (3.71) < 0.01 .999 0.00
Note: CBCL = Child Behavior Checklist (Achenbach & Edelbrock, 1991); CPRS-R = Conners’ Parent Rating
Scale Revised (Conners etal., 1998); PEP = pre-ejection period; RSA = respiratory sinus arrhythmia. All
externalizing outcomes reported in this table are mother-reports. Data are collapsed across groups given
nonsignificant differences of very small effect size on all outcomes (see text).
6 Bell et al.
negative parenting were observed for those in the imme-
diate intervention condition. Thus, parents who received
a larger dose of treatment improved more. As shown in
Table 2, parents in the immediate intervention demon-
strated improved positive and negative parenting,
whereas parents in the delayed intervention condition
showed increases in positive parenting, t(49) = 2.37,
p = .02, d = 0.38, but nonsignificant reductions of
small−medium effect size in negative parenting, t(49) =
−1.73, p = .09, d = −0.31. Furthermore, compared to
the delayed condition, parents in the immediate condi-
tion exhibited greater increases in positive parenting,
t(97) = 2.28, p = .03, d = 0.46, and greater reductions
in negative parenting, t(97) = −1.88, p = .06, d = −0.38.
It is important to note that such findings do not
threaten the validity of mediation analyses using the
combined sample. In fact, more variance in parenting
outcomes could help in detecting mediated effects.
Nevertheless, we chose to run tests of mediation within
the combined sample first, then run separate follow-up
tests in both the immediate and delayed intervention
subsamples. These latter analyses were considered
exploratory given low power to detect effects with
smaller ns (see Whisman & McClelland, 2005).
Correlations among psychophysiological and parent-
ing variables are presented in Table 3. PEP reactivity was
correlated negatively with resting PEP, r = −.28, p = .004,
and RSA reactivity, r = −.29, p = .004. No other variables
were correlated significantly, all rs .16, all ps .05.
According to Kraemer etal. (2002), “to show that M
is a mediator of treatment, [1] M would have to measure
an event or change occurring during treatment, and [2]
then it must correlate with treatment choice, hence
possibly be a result of treatment, and [3] have either a
main or interactive effect on the outcome” (p. 879). As
Table 1 indicates, the first criterion is met by virtue of
improvements in positive and negative parenting—our
putative mediators. Since everyone received an inter-
vention, the second criterion requires that changes in
parenting among the immediate intervention group
following their treatment exceed any de novo changes
in parenting among the waitlist intervention group dur-
ing the waitlist period. These effects are carried in
Treatment × Condition interactions, which were sig-
nificant for both positive and negative parenting. Thus,
changes in parenting among those in the immediate
intervention condition exceeded changes in parenting
during the waitlist period among those in the delayed
intervention condition. Finally, the third criterion is met
by testing the mediational effect statistically, as
described below.
Mediation analyses
Historically, mediation analyses in intervention research
have been tested using path analytic approaches, fol-
lowing steps set forth by Judd, Kenny, and McClelland
(2001). In large samples, the Kraemer etal. (2002) cri-
teria have been evaluated using structural equation
modeling (e.g., Beauchaine etal., 2005). A new pro-
gram, MEMORE, tests mediational effects in repeated-
measures designs using path analytic regression
(Montoya & Hayes, 2016). The advantage of MEMORE
over traditional approaches is that it estimates bootstrap
confidence intervals for direct and indirect effects, with-
out relying on multiple tests to infer mediation. In simu-
lations, the percentile bootstrap confidence interval
provides a desirable balance between Type I error and
power. In contrast, the causal steps approach is often
Table 2. Pre- to Postintervention Changes in Parenting for Participants in the Immediate and Delayed Conditions
Immediate Intervention Delayed Intervention
Variable Pre (SD) Post (SD)t(48) p d Pre (SD) Post (SD)t(49) p d
Positive parenting 23.39
4.06 < .001 0.75 22.03
2.37 .022 0.38
Negative parenting 35.04
−4.48 < .001 −0.71 28.42
−1.73 .089 −0.31
Note: PEP = pre-ejection period; RSA = respiratory sinus arrhythmia.
Table 3. Correlations Among Pretreatment
Psychophysiological and Parenting Variables for Combined
Immediate and Delayed Intervention Participants
Variable 1 2 3 4 5
1. Resting RSA
2. RSA reactivity .07
3. Resting PEP −.09 .04
4. PEP reactivity −.10 −.29* −.28*
5. Positive parenting .16 −.02 −.02 .11
6. Negative parenting .07 −.07 −.04 .16 .15
Note: PEP = pre-ejection period; RSA = respiratory sinus arrhythmia.
*p .01.
Effects of Parenting on Children’s Autonomic Function 7
too conservative (see Hayes, 2013; Montoya & Hayes,
The test of mediation of changes in resting RSA through
changes in negative parenting is shown in Figure 1.
Sample-wide increases in resting RSA from pre–post
intervention were mediated in part by reductions in
negative parenting. The indirect effect of parenting on
resting RSA was different from zero, with a 95% bias-
corrected bootstrap confidence interval of [−0.290,
−0.015] (a × b = −0.124).1 Reductions in negative par-
enting also mediated changes in PEP reactivity (b =
0.060), with a 95% bias-corrected bootstrap confidence
interval of [−1.369, −0.070] (a × b = −0.560). Thus,
reductions in negative parenting were associated with
greater PEP reactivity to incentives. Mediational effects
of changes in parenting on changes in RSA reactivity
and resting PEP were not significant (i.e., their confi-
dence intervals included zero).
As outlined above, exploratory follow-up media-
tional analyses were conducted separately for the
immediate and delayed treatment conditions to test
whether significant effects from the pooled analyses
were specific to either group. For resting RSA, media-
tional effects of parenting were not significant in either
condition: immediate treatment 95% bias-corrected con-
fidence interval of [−0.636, 0.040] (a × b = −0.253) and
delayed treatment 95% bias-corrected confidence inter-
val of [−0.201, −0.029] (a × b = −0.06). In contrast, the
mediational effect of parenting on PEP reactivity was
significant for the immediate treatment condition, 95%
bias-corrected confidence interval of [−3.085, −0.033]
(a × b = −0.124), but not for the delayed treatment
condition, 95% bias-corrected confidence interval of
[−3.082, 0.039] (a × b = −0.124).
For the combined sample, reductions in negative par-
enting mediated pre- to posttreatment improvements
in both PNS- and SNS-linked cardiac function, as
indexed by resting RSA and PEP reactivity to incentives
following an empirically supported intervention for
ADHD. The IY series and similar interventions consis-
tently yield improvements in parenting, children’s exter-
nalizing behaviors, and children’s emotion regulation
(Beauchaine et al., 2005, 2013; Eyberg etal., 2008;
Pelham & Fabiano, 2008). However, despite empirical
findings linking physiological reactivity specifically to
coercive relationship dynamics in cross-sectional stud-
ies (e.g., Crowell etal., 2014, 2017), almost no studies
have evaluated effects of parenting on children’s auto-
nomic activity/reactivity in treatment–outcome con-
texts. In fact, this is the first study that we are aware of
to evaluate mediating effects of parenting on changes
on children’s SNS- and PNS-linked cardiac activity and
reactivity. According to Kraemer etal. (2002), effects
that accrue during the course of an intervention and
account for variance in outcomes are mediators of treat-
ment response. Following transactional models, which
suggest that coercive family processes reinforce emo-
tional lability and emotion dysregulation (see
Beauchaine & Zalewski, 2016; Snyder etal., 1997), we
hypothesized that changes in parenting following the
Change in
resting RSA
Change in
negative parenting
a = –9.305 b = 0.013
c = 0.496
Fig. 1. Mediation of changes in resting RSA during treatment by changes in negative
parenting. In the figure, 1 represents treatment, a represents the link between treatment
and changes in parenting (the mediator), b represents the association between change in
RSA (the dependent variable) as a function of changes in parenting (the mediator), and c
represents the association between treatment and change in RSA. The a × b product quanti-
fies the indirect effect of changes in parenting on changes in RSA.
8 Bell et al.
IY series, which targets coercive, negative parenting
behaviors, would mediate changes in children’s auto-
nomic function.
In support of this hypothesis, improvements in chil-
dren’s resting RSA and PEP reactivity were mediated by
reductions in negative parenting in the combined sam-
ple. However, when analyses were conducted in the
immediate and delayed treatment conditions separately,
most of these effects were nonsignificant, which is
likely a result of reduced statistical power (see above)
given the relatively small number of children in each
group (n = 49–50). It is well documented that tests of
higher order interactions require larger samples than
we had available for these subgroup analyses (e.g.,
Whisman, & McClelland, 2005). Given that failure to
find mediational effects of parenting in three of the four
subsample tests was likely attributable to low power,
we discuss findings from the overall sample throughout
the remainder of this discussion.
Although it may seem unlikely that changes in chil-
dren’s psychophysiological function would be observed
following a brief intervention, preschool-aged children
demonstrate considerable neuroplasticity (e.g., Anderson
& Reidy, 2012; Tau & Peterson, 2010), and previous
research with this sample revealed improvements in
electrodermal responding, a different SNS measure (see
Beauchaine etal., 2015). Findings reported by Raine
etal. (2001) indicate that preschool interventions confer
improvements in electrodermal responding into middle
Previous research implicates coercive, harsh, and
invalidating parenting in shaping and maintaining emo-
tional lability and emotion dysregulation and in confer-
ring risk for progression to increasingly severe
externalizing behaviors across development (Beauchaine
& Zalewski, 2016; Patterson, Capaldi, & Bank, 1991;
Snyder etal., 1994, 1997). These family dynamics may
be especially potent mediators of such progression
among children who are physiologically reactive (e.g.,
Beauchaine etal., 2017; Crowell etal., 2017). Thus, evi-
dence that a parenting intervention mediated improve-
ments not only in children’s behavior but also in their
physiological responding may have important clinical
implications—especially given the wide range of adverse
outcomes associated with excessive autonomic reactivity
(e.g., Beauchaine & Thayer, 2015; Shader etal., 2017).
Future research should continue to evaluate effects
of psychosocial interventions on emotional lability and
associated autonomic function among children, over
longer follow-ups. Such research should continue to
specify dose effects to ensure that mechanisms of emo-
tional lability and emotion dysregulation are altered in
the most cost-effective manner. Analyses with larger
samples could evaluate incremental changes in physiol-
ogy associated with additional hours of parent manage-
ment training.
One limitation concerns the small number of female
participants, which precluded analyses of sex effects. In
addition, mothers accompanied their children to the lab
in all but one case. Future research on sex differences
in children’s reactions to specific parenting behaviors
may increase precision of models predicting coercive
behaviors between mothers and sons versus fathers and
daughters, for example. A second limitation concerns
diagnosing based solely on parent-reports. Given the
young age of child participants (mean age = 5.36 years,
SD = 0.92 years) and the location of the study (Seattle,
Washington), many children did not have teachers or
daycare workers to report on symptoms in a second
setting. Thus, we relied in part on nationally normed
scores on parent-reports that placed children at or above
the 95th percentile on attention problems, in addition to
meeting parent-report criteria for the hyperactive/impul-
sive or combined subtypes of ADHD using the DISC.
A third limitation is that we did not include an
untreated control group in our analyses. One could
therefore argue that changes in RSA and RSA reactivity
represent normative developmental shifts in autonomic
responding. However, observed changes in resting RSA
(0.38 Hz) were 20 or more times larger than expected
across ages 4 to 5 (0.01 Hz) and ages 5 to 6 (0.02 Hz;
see Shader etal., 2017). Thus, maturation is an unlikely
alternative explanation for our findings.
Although sample-wide pre to post changes in PEP
reactivity were not observed, individual-level changes
in PEP responding were nevertheless mediated by
reductions in negative parenting. It bears repeating that
mediation does not require significant direct effects
(Hayes, 2013), nor does it preclude potential effects of
unmeasured third variables on outcomes. The IY series
is a multifaceted intervention with numerous mecha-
nisms of action, some of which may also account for
changes in children’s autonomic function. We chose,
based on strong theoretical considerations, to test medi-
ational effects of parenting. This choice follows from
four decades of research linking negative parenting—
including coercion, aggression, and invalidation—to
children’s behavior problems, emotional lability, emo-
tion dysregulation, and autonomic reactivity (e.g.,
Beauchaine, 2015a; Beauchaine & Zalewski, 2016;
Crowell etal., 2014, 2017; Snyder, 1977; Snyder etal.,
1994, 1997). That being said, tests of other mediating
effects should be evaluated in future research.
Considerable evidence links intervention-related
changes in parenting to improvements in child behavior
(Eyberg etal., 2008; Webster-Stratton etal., 2011). How-
ever, almost no studies have evaluated changes in psy-
chophysiological function as treatment outcomes (for
an exception, see Graziano etal., 2012). Our findings
Effects of Parenting on Children’s Autonomic Function 9
therefore make a unique contribution to the literature.
Our study is also the first to use MEMORE to estimate
indirect effects of behavioral management on changes
in children’s psychophysiological function. Understand-
ing potential neurobiological mechanisms of interven-
tions can aid in (a) identifying children who are resistant
to treatment and (b) evaluating efficacy of treatments
across multiple levels of analysis.
Changes in PNS- and SNS-linked cardiac function
occurred during a relatively brief intervention for
ADHD, and changes in parenting behaviors were
observed. This study contributes to decades of research
on the role of parenting in shaping children’s behavior
and emotion regulation and underscores the impor-
tance of reducing aversive interactions among family
members. These interaction patterns appear to have
implications for children’s peripheral nervous system
responding as well as their behavior.
Author Contributions
Z.B. drafted the paper and performed statistical analyses with
T.S. Data collection was performed by C.W.-S., M.J.R., and
T.P.B. T.P.B edited the paper. All authors approved the final
version for submission.
Declaration of Conflicting Interests
C.W.-S. has disclosed a potential conflict of interest because
she disseminates these treatments and stands to gain from
favorable reports. She has voluntarily agreed to distance her-
self from certain critical research activities, including recruit-
ment, consenting, primary data handling, and data analysis.
The University of Washington has approved these arrange-
ments. M.J.R. performs Incredible Years interventions as an
independent contractor.
Research was supported by National Institute of Mental
Health Grants MH67192 and MH63699.
1. MEMORE yields unstandardized coefficients given that esti-
mation of a-paths relies on the mean of the pre-post interven-
tion difference. Standardizing variables in regression equations
changes intercepts, which are required for proper interpretation
of effects. We therefore report unstandardized coefficients.
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... The threshold chosen for statistical significance is p<0.05 (details in Figure 4). This type of mediations analysis has been recently widely used in a variety of research domains related to interventions, and in different populations (Bell et al., 2018;Boidin et al., 2020;Sidhu and Cooke, 2021 . Results ...
Full-text available
Whether complex movement training benefits inhibitory functions and transfers the effects to non-practiced motor and cognitive tasks is still unknown. The present experiment addressed this issue using a bimanual coordination paradigm. The main hypothesis was that bimanual coordination training allows for improving the involved cognitive (i.e., inhibition) mechanisms and then, transferring to non-practiced cognitive and motor tasks, that share common processes. Results confirmed that training was effective on the trained task and delayed the spontaneous transition frequency. Moreover, it transferred the benefits to untrained bimanual coordination and cognitive tasks that also involve inhibition functions. Mediation analyses confirmed that the improvement of inhibitory functions mediated the transfer of training in both the motor and cognitive tasks.
... The threshold chosen for statistical significance is p<0.05 (details in Figure 4). This type of mediations analysis has been recently widely used in a variety of research domains related to interventions, and in different populations (Bell et al., 2018;Boidin et al., 2020;Sidhu and Cooke, 2021 . Results ...
Full-text available
Introduction Whether complex movement training benefits inhibitory functions and transfers the effects to non-practiced motor and cognitive tasks is still unknown. The present experiment addressed this issue using a bimanual coordination paradigm. The main hypothesis was that bimanual coordination training allows for improving the involved cognitive (i.e., inhibition) mechanisms and then, transferring to non-practiced cognitive and motor tasks, that share common processes. Methods 17 older participants (72.1 ± 4.0 years) underwent 2 training and 3 test sessions (pre, post, and retention one week after) over three weeks. Training included maintaining bimanual coordination anti-phase pattern (AP) at high frequency while inhibiting the in-phase pattern (IP). During the test sessions, participants performed two bimanual coordination tasks and two cognitive tasks involving inhibition mechanisms. Transfer benefits of training on reaction time (RT), and total switching time (TST) were measured. In the cognitive tasks (i.e., the Colour Word Stroop Task (CWST) and the Motor and Perceptual Inhibition Test (MAPIT)), transfer effects were measured on response times and error rates. Repeated one-way measures ANOVAs and mediation analyses were conducted. Results Results confirmed that training was effective on the trained task and delayed the spontaneous transition frequency. Moreover, it transferred the benefits to untrained bimanual coordination and cognitive tasks that also involve inhibition functions. Mediation analyses confirmed that the improvement of inhibitory functions mediated the transfer of training in both the motor and cognitive tasks. Discussion This study confirmed that bimanual coordination practice can transfer training benefits to non-practiced cognitive and motor tasks since presumably they all share the same cognitive processes.
... While prior research supports the feasibility of using the live or video-feedback [65] coaching, it remains unclear whether the addition of a parent-child interactive coaching component improves outcomes within parent training programs relative to programs without an interactive component. Prior studies have identified positive parenting, negative parenting and behavior modification skills as the agents of change in reducing child behavior problems within parent training interventions [66,67]. However, unlike other parenting-focused interventions, programs that incorporate a parent-child interactive component use in vivo coaching or video feedback to allow for an individualised approach to changing the dysfunctional parent-child relationship [56,68]. ...
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The Exploring Together program is a group-based parent training program that comprises separate parent, child, and teacher components, and a combined parent–child interactive component. A cluster-randomized trial design was used to compare the Exploring Together program with (Exploring Together; ET) and without (Exploring Together-Adapted; ET-Adapted) the parent–child interactive component. One hundred and thirty-six parents and their children (aged 5–10 years) with externalizing and/or internalizing problems participated in the trial, recruited from primary schools. There was a significant reduction in negative parenting behavior across both treatment groups (ET and ET-Adapted) but no significant improvement in positive parenting behaviors. Parenting self-efficacy improved significantly across both treatment groups however there was no significant change in parenting satisfaction or parenting stress. There was no consistent evidence of superiority of one version of the Exploring Together program over the other. Further investigation regarding treatment dosage and mastery of parenting skills associated with the program is warranted.
This study examined whether children exposed to adversity would exhibit lower epigenetic age acceleration in the context of improved parenting. Children with developmental delays and externalizing behavior problems ( N = 62; M age = 36.26 months; 70.97% boys, 29.03% girls; 71% Latinx, 22.6% Black) were drawn from a larger randomized controlled trial (RCT), which randomized them to receive Internet-delivered parent–child interaction therapy (iPCIT; n = 30) or community referrals as usual (RAU; n = 32). Epigenetic age acceleration was estimated with the pediatric buccal epigenetic clock, using saliva. Adversity was assessed using parent, family, and neighborhood-level cumulative-risk indicators. Adversity interacted with Time 2 (T2) observations of positive and negative-parenting practices to predict epigenetic age acceleration 1.5 years later, regardless of treatment assignment. Children exposed to more adversity displayed lower epigenetic age acceleration when parents evidenced increased positive ( b = −0.15, p = .001) and decreased negative ( b = −0.12, p = .01) parenting practices.
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Las conductas autolesivas son extremadamente prevalentes en la población adolescente de nuestro medio, y aún más en aquellos con patología psiquiátrica, lo que adquiere importancia por su relación con la ideación suicida y el suicidio. Para profundizar en su prevención es fundamental investigar sus factores de riesgo asociados, entre los que destacan, entre otros, la exposición a eventos vitales adversos unido a una personalidad perfeccionista o impulsiva, patología psiquiátrica, síntomas depresivos o consumo inadecuado de alcohol. Este estudio explora las características sociodemográficas y clínicas asociadas al cutting en adolescentes con patología psiquiátrica. Métodos: Se lleva a cabo un estudio observacional, transversal, con muestreo oportunista y recogida de datos mediante cuestionario a un total de 40 pacientes de la Unidad de Salud Mental Infanto-Juvenil (USMIJ) del Hospital Virgen de las Nieves (HUVN) de Granada. Resultados: El 55% de los pacientes presentaron conductas autolesivas, mayormente cutting (81,8%) en brazos y muñecas, con la finalidad de calmar tensión emocional (71,4%). No se encontraron diferencias significativas entre pacientes con autolesiones y sin autolesiones en función del diagnóstico psiquiátrico, el consumo de alcohol, los antecedentes de abuso y el apoyo familiar, pero sí para la presencia de síntomas depresivos, intentos de suicidio previos y la presencia de ideación suicida, observando para el cutting mayor riesgo de ideación suicida que para el resto de tipos de autolesiones. Conclusiones: La mayoría de adolescentes atendidos en una USMIJ presentan autolesiones mediante cutting en brazos y muñecas, y lo hacen con la finalidad de aliviar tensión emocional. Los síntomas depresivos, las conductas autolesivas en relación con el suicidio y la ideación suicida son factores de riesgo en la presencia de estas, conllevando el cutting mayor riesgo de autolesión que el resto de tipos de autolesiones. Estos resultados subrayan la importancia de la prevención de las autolesiones, y concretamente del cutting, como prevención ulterior del suicidio.
Parental socialization may influence the development of children’s autonomic nervous system (ANS), a key stress-response system. However, to date no quantitative synthesis of the literature linking parenting and child ANS physiology has been conducted. To address this gap, we conducted a pre-registered meta-analysis. A systematic review of the literature identified 103 studies (n = 13,044 participants) with available effect sizes describing the association between parenting and either parasympathetic nervous system (PNS) or sympathetic nervous system (SNS) activity in children. The overall analysis revealed non-significant associations between parenting and child ANS physiology on average. However, moderation analyses revealed a positive association between more positive parenting and higher resting PNS activity that was stronger when a study was experimental rather than correlational, and when the sample included children with a clinical condition. In conclusion, well-controlled experimental studies show that positive parenting is associated with the development of higher resting PNS activity, an effect that may be stronger among children who are at elevated developmental risk.
Parental socialization may influence the development of children’s autonomic nervous system (ANS), a key stress-response system. However, to date no quantitative synthesis of the literature linking parenting and child ANS physiology has been conducted. To address this gap, we conducted a pre-registered meta-analysis. A systematic review of the literature identified 103 studies (n = 13,044 participants) with available effect sizes describing the association between parenting and either parasympathetic nervous system (PNS) or sympathetic nervous system (SNS) activity in children. The overall analysis revealed non-significant associations between parenting and child ANS physiology on average. However, moderation analyses revealed a positive association between more positive parenting and higher resting PNS activity that was stronger when a study was experimental rather than correlational, and when the sample included children with a clinical condition. In conclusion, well-controlled experimental studies show that positive parenting is associated with the development of higher resting PNS activity, an effect that may be stronger among children who are at elevated developmental risk.
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Dysregulated autonomic nervous system (ANS) activity has been associated with adolescent risk-taking and internalizing behavior, but previous results in community samples have been mixed. We investigated whether ANS activity was associated with higher risk-taking and internalizing behavior in young adolescents (age 11/12; n = 875), and whether adolescents' gender, parents' parenting style or a combination of both moderated these associations. Adolescents and their parents were recruited as part of the population-based, longitudinal Amsterdam Born Children and their Development (ABCD) study. Risk-taking behavior was assessed with the Balloon Analogue Risk Task and the personality characteristics sensation seeking and impulsivity, measured with the Substance Use Risk Profile Scale (SURPS). Internalizing behavior was assessed via the SURPS subscales anxiety sensitivity and hopelessness. Authoritative (AUTH-SW) and authoritarian (AUTH-S) parenting styles were measured with the Parenting Styles and Dimensions Questionnaire. Resting ANS activity was assessed via heart rate and respiratory sinus arrhythmia (RSA). Hierarchical, multivariable regression analyses showed higher RSA, but not heart rate, being associated with higher risk-taking behavior and sensation seeking. The associations between ANS activity and risk-taking variables were not significantly moderated by gender, parenting, or interactions between gender and parenting. Our findings suggest that RSA activity may be a relevant factor in mild to moderate risk-taking behavior in adolescents from the general population, regardless of their gender or the type of parenting they experience.
Children with autism spectrum disorder (ASD) are at considerable risk for difficulties with emotion regulation and related functioning. Although it is commonly accepted that parents contribute to adaptive child regulation, as indexed by observable child behavior, theory and recent evidence suggest that parenting may also influence relevant underlying child physiological tendencies. The current study examined concurrent associations between two elements of parental socialization of emotion and measures of both sympathetic and parasympathetic nervous system activity in 61 children with ASD aged 6 to 10 years. To index parental socialization, parents reported on their reactions to their children’s negative emotions, and parental scaffolding was coded from a dyadic problem-solving task. Children’s baseline respiratory sinus arrhythmia (RSA), electrodermal reactivity (EDA-R), and RSA reactivity in response to challenge were obtained as measures of the children’s physiological activity. Regression analyses indicated that supportive parent reactions were related to higher child baseline RSA, a biomarker of regulatory capacity. Fewer unsupportive parent reactions and higher quality scaffolding were associated with higher EDA-R, a physiological index of inhibition. The identification of these concurrent associations represents a first step in understanding the complex and likely bidirectional interplay between parent socialization and child physiological reactivity and regulation in this high-risk population.
Parent training (PT) is effective in treating early onset conduct problems (CPs), particularly when focused on altering reinforcement systems that support aggression and emotional lability. We describe PT, as well as augmenting effects of additional treatment components (e.g., child training). Effective PT alters family dynamics to increase positive interactions and decrease negative interactions, resulting in improved family climate, less negative reinforcement of emotional lability, and reduced physiological reactivity among children. Despite attempts to disaggregate PT into minimally necessary components, the whole is often greater than the sum of its parts. PT is also enhanced by adding child training, and when possible, teacher training. Early intervention is preferable, before children's CPs become embedded in deviant peer reinforcement systems.
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The objective was to determine if the latent structure of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms is best explained by a general disruptive behavior factor along with specific inattention (IN), hyperactivity/impulsivity (HI), and ODD factors (a bifactor model) whereas the latent structure of sluggish cognitive tempo (SCT) symptoms is best explained by a first-order factor independent of the bifactor model of ADHD/ODD. Parents' (n 703) and teachers' (n 366) ratings of SCT, ADHD-IN, ADHD-HI, and ODD symptoms on the Child and Adolescent Disruptive Behavior Inventory (CADBI) in a community sample of children (ages 5–13; 55% girls) were used to evaluate 4 models of symptom organization. Results indicated that a bifactor model of ADHD/ODD symptoms, in conjunction with a separate first-order SCT factor, was the best model for both parent and teacher ratings. The first-order SCT factor showed discriminant validity with the general disruptive behavior and specific IN factors in the bifactor model. In addition, higher scores on the SCT factor predicted greater academic and social impairment, even after controlling for the general disruptive behavior and 3 specific factors. Consistent with predictions from the trait-impulsivity etiological model of externalizing liability, a single, general disruptive behavior factor accounted for nearly all common variance in ADHD/ODD symptoms, whereas SCT symptoms represented a factor different from the general disruptive behavior and specific IN factor. These results provide additional support for distinguishing between SCT and ADHD-IN. The study also demonstrates how etiological models can be used to predict specific latent structures of symptom organization. Keywords: attention-deficit/hyperactivity disorder, sluggish cognitive tempo, oppositional defiant disorder, bifactor models, trait-impulsivity etiological model of ADHD Recent studies have applied a bifactor latent model to attention-deficit/hyperactivity disorder (ADHD) symptoms. This model includes a general ADHD factor, along with specific inattention (IN) and hyperactivity/impulsivity (HI) factors. The general ADHD factor accounts for common variance among ADHD symptoms, and is independent of specific IN and HI factors, whereas specific IN and HI factors account for common variance in their respective symptoms independent of the general ADHD factor. The bifactor model consistently yields better fit than the two correlated factors (IN and HI) model (e.g. Although the bifactor model always fit better than the correlated two-factor model, the specific IN and HI dimensions from the bifactor model accounted for little true score variance, over-and-above the general ADHD factor. For example, omega-hierarchical (h) values for the specific IN and HI factors in Wagner et al. (2015) were .33 and .08, respectively, with the values from Wil-loughby et al. (2015) being .25 and .10, respectively. In contrast, h values for the general ADHD factor were .86 and .83 in these two studies, respectively. These results suggest that the specific IN and HI factors contain too little true score variance to be useful as specific measures of the IN and HI dimensions independent of the
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Delay discounting—often referred to as hyperbolic discounting in the financial literature—is defined by a consistent preference for smaller, immediate rewards over larger, delayed rewards, and by failure of future consequences to curtail current consummatory behaviors. Previous research demonstrates (1) excessive delay discounting among individuals with attention-deficit/hyperactivity disorder (ADHD), (2) common neural substrates of delay discounting and hyperactive-impulsive symptoms of ADHD, and (3) associations between delay discounting and both debt burden and high interest rate borrowing. This study extends prior research by examining associations between ADHD symptoms, delay discounting, and an array of previously unevaluated financial outcomes among 544 individuals (mean age 35 years). Controlling for age, income, sex, education, and substance use, ADHD symptoms were associated with delay discounting, late credit card payments, credit card balances, use of pawn services, personal debt, and employment histories (less time spent at more jobs). Consistent with neural models of reward processing and associative learning, more of these relations were attributable to hyperactive-impulsive symptoms than inattentive symptoms. Implications for financial decision-making and directions for future research are discussed.
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Low resting RSA, and to a lesser extent excessive RSA reactivity to emotion evocation, are observed in many psychiatric disorders characterized by emotion dysregulation, including syndromes spanning the internalizing and externalizing spectra, and other conditions such as nonsuicidal self-injury. Nevertheless, some inconsistencies exist. For example, null outcomes in studies of RSA-emotion dysregulation relations are sometimes observed among younger participants. Such findings may derive from use of age inappropriate frequency bands in calculating RSA. We combine data from five published samples (N = 559) spanning ages 4 to 17 years, and reanalyze RSA data using age-appropriate respiratory frequencies. Misspecifying respiratory frequencies results in overestimates of resting RSA and underestimates of RSA reactivity, particularly among young children. Underestimates of developmental shifts in RSA and RSA reactivity from preschool to adolescence were also observed. Although correlational analyses revealed weak negative associations between resting RSA and aggression, those with clinical levels of externalizing exhibited lower resting RSA than their peers. No associations between RSA reactivity and externalizing were observed. Results confirm that age-corrected frequency bands should be used when estimating RSA, and that literature-wide overestimates of resting RSA, underestimates of RSA reactivity, and underestimates of developmental shifts in RSA and RSA reactivity may exist.
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High sensitivity and reactivity to behaviors of family members characterize several forms of psychopathology, including self-inflicted injury (SII). We examined mother-daughter behavioral and psychophysiological reactivity during a conflict discussion using nonlinear dynamics to assess asymmetrical associations within time-series data. Depressed, SII, and control adolescents and their mothers participated (N = 76 dyads). We expected that (a) mothers’ evocative behaviors would affect behavioral and psychophysiological reactivity among depressed and, especially, SII adolescents, (b) adolescents’ behaviors would not evoke mothers’ behavioral or physiological reactivity, and (c) control teens and mothers would be less reactive, with no dynamic associations in either direction. Convergent cross-mapping with dewdrop regression, which identifies directional associations, indicated that mothers’ behaviors evoked behavioral responses among depressed and SII participants, but evoked psychophysiological reactivity for SII teens only. There were no effects of adolescents’ behavior on mothers’ reactivity. Results are interpreted based on sensitivity theories and directions for further research are outlined.
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This article reviews evidence that trait impulsivity-expressed early in life as the hyperactive-impulsive and combined presentations of attentiondeficit/hyperactivity disorder (ADHD)-is a bottom-up, subcortically mediated vulnerability to all externalizing disorders. This vulnerability arises from deficient mesolimbic dopamine responding, which imbues psychological states (irritability, discontentment) that motivate excessive approach behavior (hyperactivity, impulsivity). Through complex interactions with (a) aversive motivational states that arise from largely independent subcortical systems, (b) emotion regulatory mechanisms that arise from top-down, cortical modulation of subcortical neural function, and (c) environmental risk factors that shape and maintain emotion dysregulation, trait impulsivity confers vulnerability to increasingly severe externalizing behaviors across development. This perspective highlights the importance of identifying transdiagnostic neural vulnerabilities to psychopathology; dovetails with the hierarchical, latent structure of psychopathology; and suggests that progression along the externalizing spectrum is an ontogenic process whereby a common, multifactorially inherited trait interacts with endogenous and exogenous influences to yield increasingly intractable externalizing behaviors across development. Expected final online publication date for the Annual Review of Clinical Psychology Volume 13 is May 7, 2017. Please see for revised estimates.
Researchers interested in testing mediation often use designs where participants are measured on a dependent variable Y and a mediator M in both of 2 different circumstances. The dominant approach to assessing mediation in such a design, proposed by Judd, Kenny, and McClelland (2001), relies on a series of hypothesis tests about components of the mediation model and is not based on an estimate of or formal inference about the indirect effect. In this article we recast Judd et al.'s approach in the path-analytic framework that is now commonly used in between-participant mediation analysis. By so doing, it is apparent how to estimate the indirect effect of a within-participant manipulation on some outcome through a mediator as the product of paths of influence. This path-analytic approach eliminates the need for discrete hypothesis tests about components of the model to support a claim of mediation, as Judd et al.'s method requires, because it relies only on an inference about the product of paths-the indirect effect. We generalize methods of inference for the indirect effect widely used in between-participant designs to this within-participant version of mediation analysis, including bootstrap confidence intervals and Monte Carlo confidence intervals. Using this path-analytic approach, we extend the method to models with multiple mediators operating in parallel and serially and discuss the comparison of indirect effects in these more complex models. We offer macros and code for SPSS, SAS, and Mplus that conduct these analyses. (PsycINFO Database Record