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Emotion socialization parenting interventions targeting emotional competence in young children: A systematic review and meta-analysis of randomized controlled trials
Abstract
Background:
Although emotion socialization parenting interventions are supported by a growing body of literature, their effects have yet to be systematically examined. The present systematic review and meta-analysis assesses the evidence for emotion socialization parenting interventions for parents of young children.
Methods:
Six electronic databases were systematically searched from inception to October 5th, 2022. We conducted random effects meta-analyses of randomized controlled trials of emotion socialization interventions delivered to parents of children aged 18 months to 6 years 11 months.
Results:
Twenty-six studies which reported data from 15 individual trials met the inclusion criteria. Interventions had a positive effect on positive and negative emotion socialization parenting practices (g's = 0.50) and child emotional competence (g = 0.44). Interventions also had a positive effect on positive (g = 0.74) and negative parenting behaviors (g = 0.25), parent psychological well-being (g = 0.28), and child behavioral adjustment (g = 0.34). Findings remained significant after considering potential publication bias and conducting sensitivity analyses. Two significant moderating factors emerged.
Conclusions:
Emotion socialization parenting interventions are effective for improving emotion socialization parenting practices and child emotional competence. Additional methodologically rigorous trials are needed to buttress the current evidence and provide evidence for additional moderating factors.
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Background:
Children's academic readiness has important implications for subsequent achievement and psychosocial functioning. A growing number of studies are utilizing randomized controlled trials (RCT) to examine whether responsive parenting interventions lead to positive gains in children's academic readiness. A synthesis of the extant literature is warranted to gain a precise estimate of the causal influence of responsive parenting on academic readiness, as well as to examine moderators that may serve to strengthen or weaken this effect. The main objective of this study will be to conduct a systematic review and meta-analysis of RCTs evaluating the use of responsive parenting interventions to target academic readiness: problem-solving/reasoning, language proficiency, executive functioning, and pre-academic skills (e.g., numeracy/literacy).
Methods:
Studies that took place in the early childhood period (< 6 years at baseline), targeted responsive parenting behaviours using an RCT (with control group, waitlist, or treatment as usual as a comparator), and included an outcome assessment of academic readiness will be considered for eligibility. Children and/or parents with special needs and/or disabilities will be excluded. The primary outcome is the effect of responsive parenting interventions on academic readiness. Secondary outcomes include substantive and methodological moderators and parent-mediated effects on outcomes. We will search MEDLINE, PsycINFO, ERIC, and ProQuest Dissertations & Theses Global databases from their inception onwards and we will also conduct backward/forward searching of eligible studies. Published and unpublished works will be considered. Screening, full-text assessments, and data extraction will be completed by two independent reviewers. Risk of bias will be assessed using the CLARITY tool for RCTs. Effect sizes will be calculated based on study-level standardized differences between experimental and control groups and entered into random effects models to obtain a pooled effect (meta-analysis). Moderation will be examined through Q-statistics and meta-regression to study sources of between-study variation in effect sizes. A pooled path model of mediation will be used to study parent-mediated effects.
Discussion:
Findings will illuminate causal relations between responsive parenting and academic readiness, with implications for developmental science. Findings will also guide decision making in policy and practice for supporting early childhood development and reducing social disparities in children prior to school-entry.
Systematic review registration:
PROSPERO CRD42020222143 .
Preschoolers’ emotional development typically hinges on the family emotional climate and their interactions with caregivers. This study used a randomized controlled trial to examine the treatment efficacy of an emotion coaching parenting intervention culturally adapted from the Tuning in to Kids® (TIK) program in enhancing Chinese mothers’ emotional responsiveness in parenting. A total of eighty-nine mothers with preschoolers were randomly assigned to either the intervention or waitlist control group. The TIK group received six weekly sessions of intervention on emotion coaching parenting training. The training significantly improved participating mothers’ positive involvement and the use of emotion coaching in their parenting practices. More expressive encouragement and emotion-focused reactions to children’s emotion expression, and less punitive parenting and emotional dismissing were also found in the mothers after training. Our findings provided the first evidence in a non-Western sample to support the effectiveness of such program in enhancing parents’ efficacy in facilitating their children’s emotional development.
This Cochrane‐Campbell systematic review examines the effects of group‐based parenting programmes on parents' psychosocial health. The review summarise findings from 48 studies conducted in various countries and settings including the USA, Canada, Australia, U.K., China, Germany, Japan, New Zealand and The Netherlands. The participants were adult parents with the parental responsibility for day‐to‐day care of children. A total of 4,937 participants were included in the studies. What are the main results? Parent training has positive short‐term effects on depression, anxiety, stress, anger, guilt, confidence and partner satisfaction. There was no effect on self‐esteem and none of the trials reported on aggression or adverse effects.
However, after six months there are positive effects on only two outcomes (stress and confidence), and after one year there are no significant effects on any outcomes.
The data refer primarily to mothers as there are limited data on fathers. Only one meta‐analysis was conducted for fathers, showing a statistically significant short‐term improvement in parental stress. There was no significant different in effects according to the type of programme or intervention duration.
Abstract
BACKGROUND
Parental psychosocial health can have a significant effect on the parent‐child relationship, with consequences for the later psychological health of the child. Parenting programmes have been shown to have an impact on the emotional and behavioural adjustment of children, but there have been no reviews to date of their impact on parental psychosocial wellbeing.
OBJECTIVES
To address whether group‐based parenting programmes are effective in improving parental psychosocial wellbeing (for example, anxiety, depression, guilt, confidence).
SEARCH METHODS
We searched the following databases on 5 December 2012: CENTRAL (2011, Issue 4), MEDLINE (1950 to November 2011), EMBASE (1980 to week 48, 2011), BIOSIS (1970 to 2 December 2011), CINAHL (1982 to November 2011), PsycINFO (1970 to November week 5, 2011), ERIC (1966 to November 2011), Sociological Abstracts (1952 to November 2011), Social Science Citation Index (1970 to 2 December 2011), metaRegister of Controlled Trials (5 December 2011), NSPCC Library (5 December 2011). We searched ASSIA (1980 to current) on 10 November 2012 and the National Research Register was last searched in 2005.
SELECTION CRITERIA
We included randomised controlled trials that compared a group‐based parenting programme with a control condition and used at least one standardised measure of parental psychosocial health. Control conditions could be waiting‐list, no treatment, treatment as usual or a placebo.
DATA COLLECTION AND ANALYSIS
At least two review authors extracted data independently and assessed the risk of bias in each study. We examined the studies for any information on adverse effects. We contacted authors where information was missing from trial reports. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post‐intervention scores between the intervention and control groups by the pooled standard deviation.
RESULTS
We included 48 studies that involved 4937 participants and covered three types of programme: behavioural, cognitive‐behavioural and multimodal. Overall, we found that group‐based parenting programmes led to statistically significant short‐term improvements in depression (standardised mean difference (SMD) ‐0.17, 95% confidence interval (CI) ‐0.28 to ‐0.07), anxiety (SMD ‐0.22, 95% CI ‐0.43 to ‐0.01), stress (SMD ‐0.29, 95% CI ‐0.42 to ‐0.15), anger (SMD ‐0.60, 95% CI ‐1.00 to ‐0.20), guilt (SMD ‐0.79, 95% CI ‐1.18 to ‐0.41), confidence (SMD ‐0.34, 95% CI ‐0.51 to ‐0.17) and satisfaction with the partner relationship (SMD ‐0.28, 95% CI ‐0.47 to ‐0.09). However, only stress and confidence continued to be statistically significant at six month follow‐up, and none were significant at one year. There was no evidence of any effect on self‐esteem (SMD ‐0.01, 95% CI ‐0.45 to 0.42). None of the trials reported on aggression or adverse effects.
The limited data that explicitly focused on outcomes for fathers showed a statistically significant short‐term improvement in paternal stress (SMD ‐0.43, 95% CI ‐0.79 to ‐0.06). We were unable to combine data for other outcomes and individual study results were inconclusive in terms of any effect on depressive symptoms, confidence or partner satisfaction.
AUTHORS' CONCLUSIONS
The findings of this review support the use of parenting programmes to improve the short‐term psychosocial wellbeing of parents. Further input may be required to ensure that these results are maintained. More research is needed that explicitly addresses the benefits for fathers, and that examines the comparative effectiveness of different types of programme along with the mechanisms by which such programmes bring about improvements in parental psychosocial functioning.
Plain language summary
PARENT TRAINING FOR IMPROVING PARENTAL PSYCHOSOCIAL HEALTH
Parental psychosocial health can have a significant effect on the parent‐child relationship, with consequences for the later psychological health of the child. Some parenting programmes aim to improve aspects of parental wellbeing and this review specifically looked at whether group‐based parenting programmes are effective in improving any aspects of parental psychosocial health (for example, anxiety, depression, guilt, confidence).
We searched electronic databases for randomised controlled trials in which participants had been allocated to an experimental or a control group, and which reported results from at least one scientifically standardised measure of parental psychosocial health.
We included a total of 48 studies that involved 4937 participants and covered three types of programme: behavioural, cognitive‐behavioural and multimodal. Overall, the results suggested statistically significant improvements in the short‐term for parental depression, anxiety, stress, anger, guilt, confidence and satisfaction with the partner relationship. However, only stress and confidence continued to be statistically significant at six month follow‐up, and none were significant at one year. There was no evidence of effectiveness for self‐esteem at any time point. None of the studies reported aggression or adverse outcomes.
Only four studies reported the outcomes for fathers separately. These limited data showed a statistically significant short‐term improvement in paternal stress but did not show whether the parenting programmes were helpful in terms of improving depressive symptoms, confidence or partner satisfaction.
This review shows evidence of the short‐term benefits of parenting programmes on depression, anxiety, stress, anger, guilt, confidence and satisfaction with the partner relationship. The findings suggest that further input may be needed to support parents to maintain these benefits. However, more research is needed that explicitly addresses the benefits for fathers, and that provides evidence of the comparative effectiveness of different types of programme and identifies the mechanisms involved in bringing about change.
Purpose of review:
To review recent studies on emotion-focused parenting interventions to provide clinicians with knowledge about how these approaches might be used in prevention and treatment of mental health difficulties for children, adolescents and their families.
Recent findings:
A number of emotion-focused parent interventions are reported in the literature, including emotion coaching/communication parenting programs, emotion-focused family therapy, attachment-focused parenting interventions (including those that address parental reflective functioning/mentalization), mindfulness parenting programs and behavioral programs with added emotion components. All target emotions or emotional communication to assist parents and children understand and work through emotional experiences so they are less likely to impede healthy functioning. These interventions target four main domains: exploring family of origin or early attachment/relational experiences with emotion, targeting parents' own emotion awareness and regulation, shifting parents responses to or communication with their children when emotions occur, and promoting parents' skills for assisting children to regulate emotions and behavior. This review from the last 18 months found 50 studies that evaluated programs addressing these domains.
Summary:
Whilst the dominant approach in evidence-based parenting programs has been teaching behavioral strategies, it has been recognized that a focus on emotion-related processes is important. This is especially when working to improve the attachment relationship or when parents and children experience emotion dysregulation. This review demonstrates extensive evidence to support emotion-focused parenting interventions.
Purpose of Review
Emotion regulation is recognized as a core underlying dimension common across psychiatric disorders and could be conceptualized as a transdiagnostic feature (i.e., mechanism underlying comorbidity). This review highlights recent research examining emotion regulation in children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).
Recent Findings
Difficulties with emotion regulation are increasingly recognized as common deficits in children with ADHD and ASD. Research indicates that emotion regulation transmits risk for co-occurring disorders within a diagnostic grouping (i.e., neurodevelopment disorders; homotypic comorbidity) and across different diagnostic groupings (i.e., neurodevelopmental disorder–mood disorder; heterotypic comorbidity) in children with ADHD and ASD.
Summary
While this review provides support for the conceptualization of emotion regulation as a transdiagnostic feature in ADHD and ASD, further research examining emotion regulation in children with other neurodevelopmental disorders is needed. The field of neurodevelopmental disorders should examine emotion regulation from a developmental perspective and needs to develop valid assessments of emotion regulation.
Regressions and meta-regressions are widely used to estimate patterns and effect sizes in various disciplines. However, many biological and medical analyses use relatively low sample size (N), contributing to concerns on reproducibility. What is the minimum N to identify the most plausible data pattern using regressions? Statistical power analysis is often used to answer that question, but it has its own problems and logically should follow model selection to first identify the most plausible model. Here we make null, simple linear and quadratic data with different variances and effect sizes. We then sample and use information theoretic model selection to evaluate minimum N for regression models. We also evaluate the use of coefficient of determination (R²) for this purpose; it is widely used but not recommended. With very low variance, both false positives and false negatives occurred at N < 8, but data shape was always clearly identified at N ≥ 8. With high variance, accurate inference was stable at N ≥ 25. Those outcomes were consistent at different effect sizes. Akaike Information Criterion weights (AICc wi) were essential to clearly identify patterns (e.g., simple linear vs. null); R² or adjusted R² values were not useful. We conclude that a minimum N = 8 is informative given very little variance, but minimum N ≥ 25 is required for more variance. Alternative models are better compared using information theory indices such as AIC but not R² or adjusted R². Insufficient N and R²-based model selection apparently contribute to confusion and low reproducibility in various disciplines. To avoid those problems, we recommend that research based on regressions or meta-regressions use N ≥ 25.
The current article addresses the consequences of emotion regulation (ER) for mental health. A large body of research has shown that alterations in ER are related to psychological disorders across different diagnostic categories. Because of the apparent ubiquity of ER difficulties in psychopathology, several authors have proposed that ER should be regarded as a transdiagnostic process. This article critically examines evidence regarding alterations in the use of cognitive ER strategies as a transdiagnostic process. Cognitive ER strategies are examined as 1 example of several possible ER-related processes that could be involved in psychopathology. There is consistent evidence showing that a reduced use of cognitive reappraisal and an increased use of negative rumination are present across a number of disorders, whereas increased levels of positive rumination appear to be confined to bipolar disorder. However, there is only preliminary evidence from prospective and/or experimental studies on the causal nature of altered ER strategy use in the development or maintenance of psychopathology. The article concludes by discussing future directions, including methodological and design issues, as well as implications for assessment and treatment when studying alterations in ER from a transdiagnostic perspective.
Background
Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems.
Methods
A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5–12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other.
Results
Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy.
Conclusions
Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.
The revised edition of the Handbook offers the only guide on how to conduct, report and maintain a Cochrane Review.
The second edition of The Cochrane Handbook for Systematic Reviews of Interventions contains essential guidance for preparing and maintaining Cochrane Reviews of the effects of health interventions. Designed to be an accessible resource, the Handbook will also be of interest to anyone undertaking systematic reviews of interventions outside Cochrane, and many of the principles and methods presented are appropriate for systematic reviews addressing research questions other than effects of interventions.
This fully updated edition contains extensive new material on systematic review methods addressing a wide-range of topics including network meta-analysis, equity, complex interventions, narrative synthesis, and automation. Also new to this edition, integrated throughout the Handbook, is the set of standards Cochrane expects its reviews to meet.
Written for review authors, editors, trainers and others with an interest in Cochrane Reviews, the second edition of The Cochrane Handbook for Systematic Reviews of Interventions continues to offer an invaluable resource for understanding the role of systematic reviews, critically appraising health research studies and conducting reviews.
Self-regulation is a foundational skill in childhood and underpins various positive and negative outcomes throughout childhood, adolescence and into adulthood. Parents and the way they parent their children play a key role in the development of young children’s self-regulatory capacity. However, there is limited evidence for the effectiveness of parenting interventions on child self-regulatory outcomes. This paper provides an overview of the role of parenting in the development of child self-regulation and a summary of the evidence base for parenting interventions to promote self-regulation in children under age eight, focusing on infancy, the toddler/preschooler period, and early school-age. We conclude by examining the gaps in this field of research and providing directions for future research.
A staple theme in clinical psychology, emotion regulation, or the ability to manage one's emotions, is directly linked with personal wellbeing and the ability to effectively navigate the social world. Until recently, this concept has been limited to a focus on intrapersonal processes, such as suppression. Less emphasis has been placed on developmental, social, and cultural aspects of emotion regulation. We argue here that as social beings, our engagement in emotion regulation may often occur interpersonally, with trusted others helping us to regulate our emotions. This review will highlight recent research on interpersonal emotion regulation processes.
Although research has shown fade-out of the cognitive benefits of classroom-based preschool interventions, less is known regarding the durability of social–emotional impacts. This study examines the extent to which the multicomponent Chicago School Readiness Project (CSRP) intervention lowered risk of internalizing, externalizing, attention, and social difficulties from Head Start through elementary school for 602 low-income children. Results suggest that most children in this sample showed few social–emotional difficulties over time. However, one quarter of the sample exhibited profiles of transitory or building difficulties over six years. Random assignment to the CSRP preschool intervention significantly reduced children’s odds of transitory attention and social difficulties in middle childhood, with preliminary evidence suggesting stronger impacts for children attending elementary schools characterized by low academic rigor and high neighborhood crime. CSRP was not found to be effective in preventing more robust, increasing forms of difficulty in the externalizing and attention domains. Implications for early childhood intervention and policy are discussed.
Parenting practices predict important outcomes for children, and parenting programs are potentially effective means of supporting parents to promote optimal outcomes for children. This review summarizes findings of systematic reviews of parenting programs published in the Campbell Library. Six reviews evaluated the effectiveness of a range of parenting programs in the primary and secondary prevention of behavioral problems (children aged 0–3 years), treatment of early onset conduct disorder (children aged 3–12 years), and improving outcomes for parents and children with attention-deficit hyperactivity disorder, outcomes for particular groups of parents and children (i.e., with intellectual disabilities and teenagers), and the psychosocial functioning of parents. The findings show that parenting programs are effective in improving the emotional and behavioral adjustment of children in addition to enhancing the psychosocial well-being of parents. They also suggest that further research is needed to assess their effectiveness for specific subgroups of parents in addition to their long-term effectiveness.
Decades of research have emphasized the role that coercive and ineffective discipline plays in shaping child and adolescent conduct problems, yet an emerging body of evidence has suggested that parents' emotion socialization behaviors (ESBs) (e.g., reactions to emotions, discussion of emotions, and emotion coaching) may also be implicated. This meta-analysis examined concurrent and longitudinal associations between parental ESBs and conduct problems, and tested for moderators of these associations. A systematic search identified 49 studies for which data on concurrent associations between ESBs and conduct problems were available (n = 6270), and 14 studies reporting on prospective associations (n = 1899). Parental ESBs were found to be significantly associated with concurrent (r = − 0.08) and prospective (r = − 0.11) conduct problems, in the order of small effect sizes. Key findings of moderator analyses were that ESBs were more strongly associated with conduct problems at younger ages and when ESBs were focused on the socialization of negative rather than positive emotions. Findings support the integration of ESBs into family-based models of antisocial behavior, and have the potential to inform the design of parent training interventions for the prevention and treatment of child conduct problems.
When we speak about heterogeneity in a meta-analysis, our intent is usually to understand the substantive implications of the heterogeneity. If an intervention yields a mean effect size of 50 points, we want to know if the effect size in different populations varies from 40 to 60, or from 10 to 90, because this speaks to the potential utility of the intervention. While there is a common belief that the I(2) statistic provides this information, it actually does not. In this example, if we are told that I(2) is 50%, we have no way of knowing if the effects range from 40 to 60, or from 10 to 90, or across some other range. Rather, if we want to communicate the predicted range of effects, then we should simply report this range. This gives readers the information they think is being captured by I(2) and does so in a way that is concise and unambiguous. Copyright © 2017 John Wiley & Sons, Ltd.
Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others' emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N's ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = -0.15) and understanding emotions (r = -0.20), less aware of (r = -0.28) and less accepting of their own emotions (r = -0.49), and report less emotional self-efficacy (r = -0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children's age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.
Understanding mechanisms and active ingredients of intervention is critical to training clinicians, particularly when interventions are transported from laboratories to communities. One promising active ingredient of parenting programs is clinicians’ in vivo feedback regarding parent–child interactions. The present study examined whether a form of in vivo feedback, in the moment commenting, predicted treatment retention and parent behavior change when the Attachment and Biobehavioral Catch-up (ABC) intervention was implemented in a community setting. Observational data were collected from 78 parent–child dyads (96% mothers; M age = 29 years; 81% minority; infants’ M age = 12 months; 90% minority) across 640 sessions conducted by 9 clinicians (100% female, M age = 39; 67% minority) in Hawaii. Parental behavior was assessed with a semistructured play task before and after intervention. Clinicians’ in-the-moment feedback to parents was assessed from intervention session videos. Clinicians’ frequency and quality of in-the-moment feedback predicted change in parental intrusiveness and sensitivity at posttreatment. Frequency of in-the-moment feedback also predicted likelihood of retention. Hierarchical linear modeling demonstrated strong support for these associations at the between-clinician level, and limited additional support at the within-clinician (i.e., between-case) level. Thus, a hypothesized active ingredient of treatment, in-the-moment feedback, predicted community-based ABC outcomes. The results complement lab-based evidence to suggest that in vivo feedback may be a mechanism of change in parenting interventions. Helping clinicians to provide frequent, high-quality in vivo feedback may improve parenting program outcomes in community settings.
This paper provides a critical review of measures of social and emotional development in early childhood for use within large-scale national surveys of child well-being and evaluations of early childhood interventions and initiatives. Key literature on social and emotional development was reviewed and organized around four commonly used subdomains: social competence, emotional competence, behavior problems, and self-regulation. Six measures, out of 75 which met criteria for more systematic review, were identified as good candidates for broader use with children birth to age five, based on their having a majority of 10 key features of strong assessments. The review also examines whether executive function is captured by measures of social and emotional development. Implications for enhancing the usefulness and effectiveness of social and emotional measures in the field and implications for future measures development are considered.
A randomized controlled trial (RCT) demonstrated that a novel psychotherapy, Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), effectively treats preschool-onset depression. However, little is known about which children benefit most from PCIT-ED. As positive parent-level factors are associated with lesser depressive symptoms, this study explored the potential moderating role of positive parenting relationships on PCIT-ED efficacy. This study examined mothers and their children aged 3-6 (N = 185) who participated in the PCIT-ED RCT. Children were randomized to immediate PCIT-ED treatment (n = 94) or a waitlist control condition (n = 91) that received treatment after 18 weeks. Prior to treatment, children completed a narrative story completion task that was videotaped and coded for children's positive and negative representations of their mothers. Parent-child interaction tasks were also completed pre-treatment and videotaped and coded to measure observed parenting. Odds of MDD diagnosis post-treatment were predicted by the interaction of children's negative maternal representations and treatment group (Estimate = -.68; SE = .27; [Formula: see text] = 6.45; p = .01) and the interaction of children's relatively more positive than negative maternal representations and treatment group (Estimate = .30; SE = .13; [Formula: see text] = 5.27; p = .02). Observed parenting measures did not significantly predict odds of MDD diagnosis. Thus, PCIT-ED predicted loss of MDD diagnosis for children who displayed maternal representations that were less negative, and relatively more positive than negative. Results suggest that children with relatively more positive maternal representations may be more likely to benefit from PCIT-ED, whereas children with more negative maternal representations may need targeted work to decrease negative maternal perceptions before initiating PCIT-ED in order for treatment to be most effective.
This paper examines the efficacy of a universally-offered parenting program, Tuning in to Toddlers (TOTS), that aims to improve parent emotion socialization, reduce parent and toddler stress and improve social, emotional, and behavioral functioning in toddlers. Three hundred parents of an 18–36 month old toddler were cluster randomized into intervention or control. Parents in the intervention participated in 6 × 2 h group sessions of TOTS. Baseline and 12-months post-intervention measures were collected using parent-report questionnaires and hair samples from parents and toddlers of systemic cortisol stress. Compared to controls, intervention parents reported significantly greater reductions in difficulties in emotion regulation (difficulty remaining goal directed: 95% CI.10, 1.71, p = .028; lack of access to strategies: 95% CI .62, 2.42, p = .001), emotion dismissing (beliefs: 95% CI 2.33,4.82, p < .001; behaviors: 95% CI .32, .65, p = <.001), greater increase in empathy (95% CI −2.83, −1.50, p < .001), emotion coaching (beliefs: 95% CI −2.56, −0.27, p = .016; behaviors: 95% CI −.58, −0.24, p = <.001), children's behavior (95% CI .19, 2.43, p = .022) and competence (95% CI −1.46, −0.22, p = .008). Significant greater reductions in systemic cortisol were found for intervention but not control children (95% CI .01, .35, p = .041). Findings provide preliminary support for the use of TOTS as a universal prevention program to improve parent emotion socialization and children's functioning.
Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12615000962538.
This pilot study provides a preliminary evaluation of the newly adapted one-to-one version of Tuning in to Kids (TIK), using a randomised-controlled design. One hundred and seven parents of a child aged between four and ten with parent-identified behaviour problems participated. Parent emotion socialisation, parental reflective functioning (PRF), parent and teacher-reported externalising behaviour problems and parent-reported internalising (anxiety) problems were assessed at baseline and six-month follow-up. Parents who completed the TIK one-to-one intervention reported improved emotion socialisation practices, relative to waitlist-controls. Children of parents in the intervention group also experienced more clinically significant improvement to their externalising behaviour problems, and decreased anxiety symptoms. There were no significant changes to teacher-reported behaviour problems, or to PRF, however, there was a trend towards intervention parents experiencing improvements to one aspect of PRF – Pre Mentalising. TIK one-to-one shows promise as an effective intervention approach for parents and their children with behaviour problems. Further corroboration of these effects is needed with a larger sample.
Abbreviations: Tuning in to Kids (TIK); Parental Reflective Functioning (PRF) Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12618000310268
Past studies show that emotional socialization and family accommodation are involved in children's anxiety, but research has yet to investigate whether targeting emotional socialization training (EST), family accommodation modification (FAM), or EST and FAM in tandem can reduce anxiety in children. The purpose of this study was to evaluate the efficacy of a combination of EST and FAM on improving emotion regulation (ER) and reducing anxiety symptoms in anxious children. The sample consisted of 80 children with an anxiety disorder (Mage = 6.7, SD = 0.1), and their mothers. Mothers were randomly assigned to an EST (n=17), FAM (n=16), Combined (n=17), or a waitlist control (WLC) (n=16) groups. Mothers completed The Emotion Regulation Checklist (ERC) and Spence Children’s Anxiety Scale (SCAS) at pre-test, post-test, and at 6-month of follow-up. The results showed that the EST, FAM, and Combined groups were more effective than WLC in improving ER and reducing anxiety severity at post-test and follow-up. Among the intervention groups, children in the combined group showed greater reductions in the severity of anxiety symptoms and emotion dysregulation than the other two groups. Assisting parents to use strategies that encourage healthy emotion regulation and decrease family accommodation might help reduce the severity of children's anxiety symptoms.
This chapter details version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2), the recommended tool for use in Cochrane Reviews. The RoB 2 tool is structured into domains through which bias might be introduced into the result. The chapter summarizes the main features of RoB 2 applied to individually randomized parallel-group trials. It describes the process of undertaking an assessment using the RoB 2 tool, summarizes the important issues for each domain of bias, and deals with a list of the key differences between RoB 2 and the earlier version of the tool. The domains included in RoB 2 cover all types of bias that are currently understood to affect the results of randomized trials. These are bias arising from the randomization process; bias due to deviations from intended interventions; bias due to missing outcome data; bias in measurement of the outcome; and bias in selection of the reported result.
Exposure to child maltreatment and maternal depression are significant risk factors for the development of psychopathology. Difficulties in caregiving, including poor emotion socialization behavior, may mediate these associations. Thus, enhancing supportive parent emotion socialization may be a key transdiagnostic target for preventive interventions designed for these families. Reminiscing and Emotion Training (RET) is a brief relational intervention designed to improve maternal emotion socialization behavior by enhancing maltreating mothers’ sensitive guidance during reminiscing with their young children. This study evaluated associations between maltreatment, maternal depressive symptoms, and the RET intervention with changes in children’s maladjustment across one year following the intervention, and examined the extent to which intervention-related improvement in maternal emotion socialization mediated change in children’s maladjustment. Participants were 242 children (aged 36 to 86 months) and their mothers from maltreating (66%) and nonmaltreating (34%) families. Results indicated that RET intervention-related improvement in maternal sensitive guidance mediated the effects of RET on reduced child maladjustment among maltreated children one year later. By comparison, poor sensitive guidance mediated the effects of maltreatment on higher child maladjustment among families that did not receive the RET intervention. Direct effects of maternal depressive symptoms on child maladjustment were also observed. This suggests RET is effective in facilitating emotional and behavioral adjustment in maltreated children by improving maltreating mothers’ emotional socialization behaviors.
Dysregulation in children's physiological stress systems is a key process linking early adversity to poor health and psychopathology. Thus, interventions that improve children's stress physiology may help prevent deleterious health outcomes. Reminiscing and Emotion Training (RET) is a brief relational intervention designed to improve maternal caregiving support by enhancing maltreating mothers’ capacity to reminisce with their young children. This study evaluated associations between maltreatment, intimate partner violence, and the RET intervention with changes in children's diurnal cortisol regulation across the 1 year following the intervention, and the extent to which improvements in maternal elaborative reminiscing differed between intervention groups and mediated change in children's physiological functioning. Participants were 237 children (aged 36 to 86 months) and their mothers. Results indicated that the RET intervention was associated with significant positive change in elaborative reminiscing, which was sustained over time. Mothers’ elaboration immediately after the intervention served as a mediator of RET's effects on improvements in children's diurnal cortisol regulation (steeper diurnal slopes) from baseline to 1 year following intervention. This suggests RET is effective in facilitating physiological regulation among maltreated children.
Technology-assisted interventions have been identified as a means to increase accessibility and enhance engagement of parenting programs. The current meta-analytic review examines the effectiveness of these interventions in families experiencing social disadvantage. A literature search was conducted spanning March 2007–June 2019. Nine studies met inclusion criteria (total of 864 participants) which included an evaluation of a parenting intervention for families with at least one of the following demographic challenges, low socioeconomic status, single parenthood, and/or young parenthood. Interventions (or a component of the intervention) were delivered by computer, cell phone, smartphone, and/or tablet. Data were organized into three categories: parental psychological well-being (e.g., self-esteem, social support), parenting (e.g., observed or self-reported parenting behavior), and child behavior (e.g., disruptive behavior). Effect sizes (Hedges’ g) were calculated and moderators (i.e., contact with an interventionist, intervention length, publication year, % female parents, mean parent age, parental education, % minority, and child age) were examined through Q-statistics and meta-regression, as appropriate. Intervention showed a near-significant impact on parental psychological well-being (g = .35, p = .051). Furthermore, interventions that did not include direct contact with an interventionist showed no evidence of effectiveness (g = − .02); interventions that incorporated contact were significantly more effective (g = .68). In addition, intervention length moderated intervention effectiveness; shorter interventions yielded greater improvements in well-being, compared with longer interventions. Interventions were also associated with significant improvements in parenting (g = .38) and child behavior (g = .39). These findings provide support for the use of technology-assisted parenting interventions in populations experiencing social disadvantage.
Parents' behaviors-particularly their emotion socialization behaviors (ESBs)-drive children's emotion socialization (Eisenberg, Cumberland, & Spinrad, 1998). We propose that a major next step in the effort to promote healthy emotional development is to improve the field's understanding of the most proximal contributor to parent ESBs: parents' own experience and regulation of emotions in the context of caregiving. As an initial step, this paper integrates Eisenberg and colleagues' model of emotion socialization with theoretical and empirical work on parental emotion. We review the literature on the emotionally evocative nature of parenting, which influences parental ESBs, including parents' expressions of emotions and their responses to children's emotions. However, whereas parental emotions influence behavior, they do not necessarily determine it; parents may regulate their emotions to engage in optimal ESBs. Thus, parental regulation contributes to emotion socialization not only by modeling emotion regulation strategies for children, but also by influencing the quality of parents' ESBs. From a clinical perspective, parental emotion regulation is of utmost importance due to the degree of parental involvement in interventions for childhood emotional and behavioral disorders, which are often aimed at promoting child self-regulation. To illustrate practical applications of Eisenberg's model, we discuss evidence-based practices that include enhancement of parent emotion regulation as a primary target, with the ultimate goal of promoting child emotional development. Ultimately, we aim to spur future theoretical, empirical, and translational work in this area. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Maltreated children are susceptible to dysregulation, but developmental mechanisms at the family level that influence this process are understudied. In the current investigation, 4 mediators (positive parenting, positive and negative family expressiveness, and maternal sensitive guidance during reminiscing) were examined as process variables through which maltreatment relates to 2 dimensions of child emotional self-regulation (adaptive emotion regulation and lability/negativity) measured across 3 time points (baseline, 2 months, and 6 months later) using longitudinal mediation analysis with latent growth modeling. These processes were evaluated in the context of a randomized controlled trial of a brief intervention aimed at improving maternal sensitive guidance during reminiscing. Participants included 160 maltreating mothers randomized into intervention (n = 81) or control intervention (n = 79) conditions and 78 demographically matched, nonmaltreating mothers and their 3- to 6-year-old children (N = 238). In the primary analysis, maternal sensitive guidance at baseline mediated relations between early maltreatment and emotion regulation and lability/negativity at 6 months, and latent change in emotion regulation across the 3 time points. Additionally, the intervention predicted steeper positive change in emotion regulation. In the secondary analysis, there was evidence of indirect effects of the intervention on emotional self-regulation through maternal sensitive guidance, positive parenting, and positive family expressiveness. Implications and future directions are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
This special issue consists of 20 articles that focus on issues related to Eisenberg and colleagues' (Eisenberg, Cumberland, & Spinrad, 1998; Eisenberg, Spinrad, & Cumberland, 1998) model of emotion socialization processes and its relevance for understanding a range of aspects of children's socioemotional functioning. The various papers have addressed a variety of issues including key mediating pathways, predictions of emotion-related socialization behaviors, moderators of pathways, and various potential outcomes of emotion-related socialization behaviors. Methods used in the articles include experimental interventions and nonexperimental longitudinal studies. The goals for this commentary include organizing the findings in this special issue to better highlight their relevance for the 1998 heuristic model and suggesting issues to consider in future research. Moreover, some gaps in the literature are noted. Finally, several minor changes to the model are suggested. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Emotion regulation patterns are shaped, in part, by the quality of interpersonal interactions during early development. Given the important contribution of caregiver emotion socialization, parenting programs targeting these socialization practices represent an effective method of preventative intervention for childhood difficulties with emotion regulation. This review examines emotion socialization parenting programs that target the development of emotion regulation in young children aged 0-6. Through a systematic search of multiple databases, 1117 articles were retrieved for title, abstract, and full-text screening. After screening, 12 articles remained and were summarized using a narrative approach. Herein, we provide an overview of 3 main intervention frameworks: Tuning in to Kids (TIK), Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), and Emotion Enhanced Triple P (EETP). Overall, these emotion socialization programs have demonstrated efficacy in their ability to improve parenting behaviors related to the coaching of young children's emotion regulation; however, there has been limited examination of their effectiveness in promoting children's emotion regulation. Future research is required to address this limitation, with rigorous parenting intervention studies incorporating valid assessments of children's emotion regulation in order to promote children's development of adaptive emotion regulation.
To evaluate Tuning in to Kids (TIK), an emotion‐focused parenting program for mothers and preschool children with disruptive behavior problems in Iran. Disruptive behaviors occur in approximately 23% of Iranian children and are associated with poorer emotional competence. The TIK parenting program was used to improve children's emotion competence and behavior by focusing on parent emotion socialization practices and emotion‐coaching skills. Fifty‐four children (3–6 years of age) were screened for behavior problems and randomly assigned to intervention or waitlist control conditions. Mothers in the intervention condition attended a six‐session version of the TIK program with two booster sessions at 2‐month intervals. Mothers completed questionnaires assessing children's behavior and emotional competence as well as parents' emotional socialization and emotion regulation at preintervention, postintervention, and 3‐month follow‐up. Compared with those in the control condition, mothers in the intervention condition reported statistically lower emotion dismissive parenting, child behavior problems, and emotion lability, as well as more emotion coaching. TIK shows promise as a way of enhancing parent emotion socialization resulting in improved child behavior and emotional competence in children with disruptive behavior problems. The findings suggest the program is a useful addition to existing parenting programs used in Iran.
Reductions in positive affect are a salient feature of preschool-onset major depressive disorder. Yet, little is known about the psychophysiological correlates of this blunted positive affect and whether reduced physiological responding to pleasant stimuli may differentiate depressed and healthy young children. 120 four-to-seven year old children with current depression and 63 psychiatrically healthy 4-to-7 year old children completed a simple picture-viewing task of pleasant and neutral pictures while event-related potentials (ERPs) were recorded. The early-childhood version of the Kiddie Schedule for Affective Disorders and Depression was used to establish psychiatric diagnoses. A one-way ANCOVA was used to test for group differences in response to pleasant and neutral pictures. Young children with depression showed a reduced response to pleasant vs. neutral pictures (LPP), after controlling for children’s age (F(1,180) = 4.15, p = 0.04, η2 = 0.02). The LPP for the children with preschool-onset depression (M = 0.99, SE = 0.65) was significantly smaller than the LPP in the healthy group of young children (M = 3.27, SE = 0.90). This difference did not vary as a function of depression or anhedonia severity within the group with depression or the healthy children. Similar to older children and adolescents with depression, young children with depression display reductions in responsivity to pleasant stimuli as indexed by the LPP. These findings extend prior findings indicating a blunted response to pleasant stimuli in preschool- onset depression. Given the greater neuroplasticity of emotional response and regulation, these findings suggest clinical attention to emotional response to pleasure is an important target in preschool-onset depression. Clinical trial registration information: A Randomized Control Trial of PCIT-ED for Preschool Depression; http://clinicaltrials.gov/;NCT02076425.
The current investigation reports the results of a randomized controlled trial of a brief, relational intervention for maltreated preschool-aged children and their mothers, called Reminiscing and Emotion Training (RET). RET facilitates elaborative and emotionally supportive parent-child communication, which is an essential component of the parent-child relationship and is especially relevant for the preschool age period. Participants were 248 children between the ages of 3- to 6-years-old and their mothers. Following a baseline assessment, 165 maltreating families were randomized into RET or a Community Standard (CS) condition in which families received case management and written parenting information; 83 families participated in the nonmaltreating comparison condition. Results indicated that the key mechanisms targeted by the RET interventions were enhanced, such that mothers who participated in RET were significantly better in elaboration and sensitive guidance during reminiscing at the posttest than were maltreating mothers who did not receive the intervention, with medium to large effect sizes; additionally, mothers in the RET group were more elaborative than mothers from the nonmaltreatment group. Children in the RET condition also contributed significantly more memories and had better emotional knowledge than did children in the CS condition, controlling for baseline values and language, and approximated the functioning of nonmaltreated children. These findings add to a growing literature underscoring the benefits of brief, focused, relational interventions for maltreated children and their caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Objective:
An adaptation of Parent Child Interaction Therapy (PCIT) with a novel Emotion Development(ED) module has shown efficacy for the treatment of early childhood depression. Children who received PCIT-ED also showed healthy alterations in neural response to reward. We investigated whether the novel ED module made a unique contribution to the treatment of depression and neural response to reward and whether child directed intervention (CDI) and parent directed intervention (PDI) modules (standard elements of PCIT) were also effective.
Method:
Dyads who participated in a randomized controlled trial of PCIT that compared the active PCIT-ED to a wait list (WL) condition were assessed at the completion of each module of PCIT-ED (CDI, PDI, ED) or WL time equivalent for child depression and other symptoms, parenting styles, stress, and depression. Event related potentials (ERPs) during a reward task were obtained at the end of standard PCIT and after the novel ED module.
Results:
Study findings showed that the ED module as well as some elements of standard PCIT were effective in reducing child depression and other forms of psychopathology. Changes in the child's neural response to reward and parental response to child emotional expression were specific to the ED module.
Conclusion:
Study findings suggest that the novel ED module has added efficacy for the treatment of early childhood depression, as well as unique efficacy in changing neural responses to reward and parenting response to child emotional expression. These findings can inform clinical uses of this treatment in a modular fashion. Future studies are needed that control for session number and order of PCIT-ED modules.
Emotion dysregulation is defined as patterns of emotional experience or expression that interfere with goal-directed activity. This paper considers this functionalist definition from a developmental perspective with the goal of elaborating this approach with respect to its central questions. What are the goals that are impeded by emotionally dysregulated responding, and what alternative goals might motivate emotion dysregulation? What are the developmental processes by which these goals take shape, and what are the influences of the family context, and especially of central relationships in the family, in their emergence? How does this functionalist account address the complex interaction of experience and developing biological processes that also influence emotion regulation and dysregulation? Drawing on research literature concerning children at risk for affective psychopathology and considering relevant examples of the interaction of biology and context, this discussion offers a portrayal of emotion dysregulation as a biologically dynamic, experience-based aspect of adaptation to environments and relationships that, in conditions of risk for the emergence of developmental psychopathology, motivates patterns of emotional responding that serve immediate coping often at the cost of long-term maladaptation. Implications for emotions theory and the study of developmental psychopathology are also considered.
Fathers play an important role in shaping their children's emotional competence although most literature has focused on the influence of mothers. Dads Tuning in to Kids (Dads TIK) is a parenting program that teaches fathers to coach their children in learning about emotions, while also helping fathers increase awareness and regulation of their own emotions. A randomized controlled efficacy trial of Dads TIK was conducted with a community sample of 162 fathers of a 4‐year old child attending preschool in Melbourne, Australia. Those allocated to the intervention attended a 7‐session manualized group program. Questionnaires were completed by fathers, the fathers’ partners and the children's teachers at baseline and 6 month follow‐up. Results were that fathers in the intervention condition but not control condition reported significant increases in emotional socialization, parenting satisfaction and efficacy, and reductions in their children's difficult behaviors. Partners of fathers in the intervention condition reported reductions in their own emotion dismissing parenting and improvements in psychological wellbeing. Partners and teachers reported significant improvements in children's behavior across both intervention and control conditions. These findings suggest a father‐focused program appears to lead to changes in fathers’ emotion socialization skills that may have benefits for partners’ functioning and children's behavior.
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Objective:
Clinical depression in children as young as age 3 has been validated, and prevalence rates are similar to the school-age disorder. Homotypic continuity between early and later childhood depression has been observed, with alterations in brain function and structure similar to those reported in depressed adults. These findings highlight the importance of identifying and treating depression as early as developmentally possible, given the relative treatment resistance and small effect sizes for treatments later in life. The authors conducted a randomized controlled trial of a dyadic parent-child psychotherapy for early childhood depression that focuses on enhancing the child's emotional competence and emotion regulation.
Method:
A modified version of the empirically tested parent-child interaction therapy with a novel "emotion development" module (PCIT-ED) was compared with a waiting list condition in a randomized controlled trial in 229 parent-child dyads with children 3-6.11 years of age. Both study arms lasted 18 weeks.
Results:
Children in the PCIT-ED group had lower rates of depression (primary outcome), lower depression severity, and lower impairment compared with those in the waiting list condition (Cohen's d values, >1.0). Measures of child emotional functioning and parenting stress and depression were significantly improved in the PCIT-ED group.
Conclusions:
The findings from this randomized controlled trial of a parent-child psychotherapy for early childhood depression suggest that earlier identification and intervention in this chronic and relapsing disorder represents a key new pathway for more effective treatment. Manualized PCIT-ED, administered by master's-level clinicians, is feasible for delivery in community health settings.
A large body of research has implicated difficulties in emotion regulation as central to the development and maintenance of psychopathology. Emotion regulation has therefore been proposed as a transdiagnostic construct or an underlying mechanism in psychopathology. The transdiagnostic role of emotion regulation has yet to be systematically examined within the psychological treatment outcome literature. It can be proposed that if emotion regulation is indeed a transdiagnostic construct central to the maintenance of psychopathology, then changes in emotion regulation difficulties will occur after effective treatment and this will occur for different disorders. We conducted a systematic review, identifying 67 studies that measured changes in both emotion regulation and symptoms of psychopathology following a psychological intervention for anxiety, depression, substance use, eating pathology or borderline personality disorder. Results demonstrated that regardless of the intervention or disorder, both maladaptive emotion regulation strategy use and overall emotion dysregulation were found to significantly decrease following treatment in all but two studies. Parallel decreases were also found in symptoms of anxiety, depression, substance use, eating pathology and borderline personality disorder. These results contribute to the growing body of evidence supporting the conceptualization of emotion regulation as a transdiagnostic construct. The present study discusses the important implications of these findings for the development of unified treatments that target emotion regulation for individuals who present with multiple disorders.
Regulating emotions well is critical for promoting social and emotional health among children and adolescents. Parents play a prominent role in how children develop emotion regulation. In 2007, Morris et al. proposed a tripartite model suggesting that parents influence children's emotion regulation through three mechanisms: children's observation of parents' emotion regulation, emotion-related parenting practices, and the emotional climate of the family. Over the past decade, we have conducted many studies that support this model, which we summarize here along with other research related to parenting and emotion regulation. We also discuss recent research on the effects of parenting on the neural circuitry involved in emotion regulation and highlight potential directions for research. Finally, we suggest how this research can aid prevention and intervention efforts to help families.
With a growing body of literature demonstrating the link between parent emotion socialization (the way in which parents model, react to, or teach children about emotions) and children’s emotional competence, there is an increasing interest in identifying the determinants of parent emotion socialization. Stress and the way parents regulate their emotional responses to stress are understood to play a significant role in determining parents’ capacity to socialize children’s emotional learning in positive ways. When parents have difficulty managing their own emotional responses (e.g., under conditions of high stress), their efforts to parent effectively and socialize their children’s emotional learning can be compromised. In this chapter, we review the empirical literature that has explored the relationship between stress, parent functioning (specifically parent’s own emotion awareness, regulation, and mental health), parent emotion socialization (especially emotion coaching) and children’s emotional, social, and behavioral functioning. In doing so, we consider how problematic ways of coping with stress are implicated in mental health difficulties and affect parents’ responsiveness to interventions. Then, we outline how we have targeted parent emotion regulation in our emotion socialization parenting program (Tuning in to Kids) that provides parents with skills to cope with stress more effectively. Finally, using data from our previously published intervention trials we reanalyze whether parent emotion awareness, regulation, and mental health are determinants of how well parents respond to this parenting program.
We investigated outcomes of Dads Tuning In to Kids, a new seven-session group program targeting paternal emotion-socialization practices, which are related to children's social and emotional functioning. In a randomized control trial with 162 fathers of children between 3 and 6 years of age, intervention fathers (n = 87) and waitlist control fathers (n = 75) completed questionnaires at baseline (pre-program) and 10 weeks later (post-program). Compared to control fathers, intervention fathers statistically increased in empathy, encouragement of emotion expression, and parenting efficacy, and decreased in emotion-dismissing beliefs, dismissive reactions to children's negative emotions, and hostile parenting responses. They also reported improved child behavior. These findings offer preliminary support for this program for fathers.
Purpose of the research:
Burgeoning evidence that modifiable parental factors can influence children's and adolescents' risk for depression and anxiety indicates that parents can play a crucial role in prevention of these disorders in their children. However, it remains unclear whether preventive interventions that are directed primarily at the parent (i.e. where the parent receives more than half of the intervention) are effective in reducing child internalizing (including both depression and anxiety) problems in the longer term.
Principal results:
Compared to a range of comparison conditions, parenting interventions reduced child internalizing problems, at a minimum of 6months after the intervention was delivered. Mean effects were very small for measures of internalizing and depressive symptoms, and small for measures of anxiety symptoms. Pooled effects for anxiety diagnoses were significant and indicated a number needed to treat (NNT) of 10. Pooled effects for depression diagnoses approached significance but suggested a NNT of 11. These results were based on effects reported at the longest follow-up interval for each included study, which ranged from 6months up to 15years for internalizing measures, 5.5years for depressive measures, and 11years for anxiety measures.
Major conclusions:
Our findings underscore the likely benefits of increasing parental involvement in preventing internalizing problems, particularly anxiety problems, in young people.
Background:
Emotional and behavioural problems in children are common. Research suggests that parenting has an important role to play in helping children to become well-adjusted, and that the first few months and years are especially important. Parenting programmes may have a role to play in improving the emotional and behavioural adjustment of infants and toddlers, and this review examined their effectiveness with parents and carers of young children.
Objectives:
1. To establish whether group-based parenting programmes are effective in improving the emotional and behavioural adjustment of young children (maximum mean age of three years and 11 months); and2. To assess whether parenting programmes are effective in the primary prevention of emotional and behavioural problems.
Search methods:
In July 2015 we searched CENTRAL (the Cochrane Library), Ovid MEDLINE, Embase (Ovid), and 10 other databases. We also searched two trial registers and handsearched reference lists of included studies and relevant systematic reviews.
Selection criteria:
Two reviewers independently assessed the records retrieved by the search. We included randomised controlled trials (RCTs) and quasi-RCTs of group-based parenting programmes that had used at least one standardised instrument to measure emotional and behavioural adjustment in children.
Data collection and analysis:
One reviewer extracted data and a second reviewer checked the extracted data. We presented the results for each outcome in each study as standardised mean differences (SMDs) with 95% confidence intervals (CIs). Where appropriate, we combined the results in a meta-analysis using a random-effects model. We used the GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) approach to assess the overall quality of the body of evidence for each outcome.
Main results:
We identified 22 RCTs and two quasi-RCTs evaluating the effectiveness of group-based parenting programmes in improving the emotional and behavioural adjustment of children aged up to three years and 11 months (maximum mean age three years 11 months).The total number of participants in the studies were 3161 parents and their young children. Eight studies were conducted in the USA, five in the UK, four in Canada, five in Australia, one in Mexico, and one in Peru. All of the included studies were of behavioural, cognitive-behavioural or videotape modelling parenting programmes.We judged 50% (or more) of the included studies to be at low risk for selection bias, detection bias (observer-reported outcomes), attrition bias, selective reporting bias, and other bias. As it is not possible to blind participants and personnel to the type of intervention in these trials, we judged all studies to have high risk of performance bias. Also, there was a high risk of detection bias in the 20 studies that included parent-reported outcomes.The results provide evidence that group-based parenting programmes reduce overall emotional and behavioural problems (SMD -0.81, 95% CI -1.37 to -0.25; 5 studies, 280 participants, low quality evidence) based on total parent-reported data assessed at postintervention. This result was not, however, maintained when two quasi-RCTs were removed as part of a sensitivity analysis (SMD -0.67, 95% CI -1.43 to 0.09; 3 studies, 221 participants). The results of data from subscales show evidence of reduced total externalising problems (SMD -0.23, 95% CI -0.46 to -0.01; 8 studies, 989 participants, moderate quality evidence). Single study results show very low quality evidence of reductions in externalising problems hyperactivity-inattention subscale (SMD -1.34; 95% CI -2.37 to -0.31; 19 participants), low quality evidence of no effect on total internalising problems (SMD 0.34; 95% CI -0.12 to 0.81; 73 participants), and very low quality evidence of an increase in social skills (SMD 3.59; 95% CI 2.42 to 4.76; 32 participants), based on parent-reported data assessed at postintervention. Results for secondary outcomes, which were also measured using subscales, show an impact on parent-child interaction in terms of reduced negative behaviour (SMD -0.22, 95% CI -0.39 to -0.06; 7 studies, 941 participants, moderate quality evidence), and improved positive behaviour (SMD 0.48, 95% CI 0.17 to 0.79; 4 studies, 173 participants, moderate quality evidence) as rated by independent observers postintervention. No further meta-analyses were possible. Results of subgroup analyses show no evidence for treatment duration (seven weeks or less versus more than eight weeks) and inconclusive evidence for prevention versus treatment interventions.
Authors' conclusions:
The findings of this review, which relate to the broad group of universal and at-risk (targeted) children and parents, provide tentative support for the use of group-based parenting programmes to improve the overall emotional and behavioural adjustment of children with a maximum mean age of three years and 11 months, in the short-term. There is, however, a need for more research regarding the role that these programmes might play in the primary prevention of both emotional and behavioural problems, and their long-term effectiveness.
Context: Childhood depression is a serious and relapsing psychiatric disorder. However, to date studies have focused mostly on children aged 6 years and older. Validation for depression in preschool children has been provided by 2 independent study samples. While several studies have demonstrated stability and poor outcomes of internalizing symptoms in preschoolers, there has not yet been longitudinal data available to inform the course of preschool depression and whether it shows homotypic continuity into early childhood. Objective: To examine the 24-month course of preschool depression and whether it showed homotypic vs heterotypic continuity or was a developmentally transient phenomenon. Design: Blindly rated, prospective, 24-month, longitudinal follow-up study. Setting: Community sites. Patients: Three hundred six preschoolers aged 3 to 6 years recruited from community sites and oversampled for symptoms of depression. Main Outcome Measure: Recurrence/stability of depression and predictors of course. Results: Preschoolers with depression at baseline had the highest likelihood of subsequent depression 12 and/or 24 months later compared with preschoolers with no baseline disorder and with those who had other psychiatric disorders. Preschoolers with depression at baseline were more likely to have later depression rather than other psychiatric disorders. Findings from a logistic regression analysis indicated that when controlling for demographic variables, risk factors, and comorbid disorders, depression during the preschool period and family history of affective disorders were the most robust and significant predictors of later depression. Conclusions: Preschool depression, similar to childhood depression, is not a developmentally transient syndrome but rather shows chronicity and/or recurrence. Homotypic continuity of preschool MDD during a 24-month period was found. These results underscore the clinical and public health importance of identification of depression as early as preschool. Further follow-up of preschoolers with depression is warranted to inform the longitudinal course throughout childhood.