Moderators and mediators of a maternal depression treatment study: Impact of maternal trauma and parenting on child outcomes

ObjectiveTreatment of maternal depression with psychotherapy has been shown to confer indirect benefits to school-age offspring with psychiatric disorders. The current study sought to understand mechanisms by which improvement in depressed mothers, with and without histories of trauma and treated with psychotherapy, produce changes in children who struggle with psychiatric illnesses themselves. We hypothesized that maternal history of childhood trauma would moderate the relationship between maternal and child outcomes and that increased positive and decreased negative parenting behaviors would mediate the relationship between maternal and child outcomes. We also examined whether maternal history of trauma would moderate the mediational effects of parenting behaviors.MethodsParticipants were dyads (n = 62) of mothers with major depressive disorder and their children, ages 7–18, with at least one internalizing disorder. Mothers were treated with nine sessions of psychotherapy and children were treated openly in the community. Dyads were evaluated every three months over one year.ResultsMaternal improvement in depressive symptoms was associated, in a lagged fashion, with child improvement in functioning six months later. There was a significant interaction of time and change in maternal symptoms [F(1, 45) = 5.84, p = 0.02], where change in maternal depressive symptoms from baseline to six months was robustly associated with change in child functioning from baseline to 12 months (β = 0.49, p = 0.0002). Maternal history of childhood sexual abuse moderated the association between change in maternal and child depressive symptoms [F(1,87) = 5.8, p = 0.02], and maternal history of physical neglect moderated the relationship between improvement in maternal depression and improvement in child functioning [F(1,36) = 4.34, p = 0.04], where significant associations between maternal and child outcomes were only found in mothers without histories of sexual abuse or physical neglect. Increase in positive parenting strategies (acceptance) by mothers mediated 6-month lagged associations between maternal and child outcomes, but reduction in negative parenting strategies (psychological control) did not. Maternal history of childhood emotional neglect moderated the mediational model, such that improved positive parenting did not explain lagged improvement in child depression among the subset of mothers with childhood histories of emotional neglect.ConclusionsIn dyads comprised of depressed mothers and school-age children with internalizing disorders, children improved when mothers improved, but not among those whose mothers who had histories of sexual abuse or physical neglect. Increased use of positive parenting strategies among mothers accounted for lagged relationships between improvement in maternal depressive symptoms and improvement in child functioning. This pattern was not, however, observed among mothers with childhood histories of emotional neglect. Interventions that directly enhance positive parenting and more rapidly change these behaviors may hasten improvement in offspring. Offspring of depressed mothers with histories of early trauma are at high risk for poor outcomes, even when their mothers receive depression treatment.     

Family context, victimization, and child trauma symptoms: variations in safe, stable, and nurturing relationships during early and middle childhood

Based on a nationally representative sample of 2,017 children age 2-9 years, this study examines variations in "safe, stable, and nurturing" relationships (SSNRs), including several forms of family perpetrated victimization, and documents associations between these factors and child trauma symptoms. Findings show that many children were exposed to multiple forms of victimization within the family (such as physical or sexual abuse, emotional maltreatment, child neglect, sibling victimization, and witnessing family violence), as evidenced by substantial intercorrelations among the different forms of victimization. Moreover, victimization exposure was significantly associated with several indices of parental dysfunction, family adversity, residential instability, and problematic parenting practices. Of all SSNR variables considered, emotional abuse and inconsistent or hostile parenting emerged as having the most powerful independent effects on child trauma symptoms. Also, findings supported a cumulative risk model, whereby trauma symptom levels increased with each additional SSNR risk factor to which children were exposed. Implications for research and practice are discussed.     

Maternal Psychological Control,Use of Supportive Parenting,and Childhood Depressive Symptoms

The current study, operating from a stress-process framework, examined the interactive effects of supportive parenting practices (i.e., mothers’ use of positive communication, positive parenting, and parental involvement) and maternal psychological control on mother- and child-reported child depressive symptoms in a community-recruited sample of 9–12 year-olds. Discrepancies between reports of depressive symptoms were also examined. Maternal psychological control was uniquely associated with child-, not mother-, reported depressive symptoms. Parental involvement was uniquely associated with mother-, not child-, reported depressive symptoms. Positive parent–child communication was associated with both reports of child depressive symptoms at the bivariate level, but not when unique associations were examined. Positive parenting was unrelated to either report of depressive symptoms. No interaction effects were detected. The current findings highlight the differential importance of parenting practices on child depressive symptoms, and also indicate the necessity of gathering both parent and child reports of symptomatology and family functioning.     

Early predictors of school-age behavior problems and social skills in children with intraventricular hemorrhage (IVH) and/or extremely low birthweight (ELBW)

Research findings: Child and family characteristics from early infancy (birth–3 months adjusted age, AA) and toddler period (24–30 months) were examined as potential predictors of behavior problems and social skills at 7.5 years of age in 90 LBW infants with IVH and/or ELBW who were part of a longitudinal study of early intervention effectiveness. Severity of medical problems at birth and child temperament at 3 months AA were associated with future social skill levels, but not with behavior problems. Family variables in the first months of the child's life including low income, single parent household, and high parenting stress were significantly correlated with behavior problems at 7.5 years of age. Difficult temperament and elevated parenting stress in the toddler period were strongly associated with later behavior problems. Toddler developmental quotient (DQ) was a strong predictor of future social skills. Practice or policy: These data highlight the importance of early intervention that targets child behavior and emotional adjustment along with cognitive development, especially in low income and single parent households. Interventions that target parent-child interaction and parent stress are also crucial in these populations, even beyond the birth-three period.     

Perinatal depression,PTSD, and trauma: Impact on mother–infant attachment and interventions to mitigate the transmission of risk

Abstract

Early interactions between infants and their caregivers are fundamental to child development, and the parent–infant relationship is believed to provide the foundation for healthy and secure attachment relationships and for infant mental health. Over time, these secure attachment relationships become the backbone for positive child outcomes across development. Abundant research to date confirms that parental mental illness, including depression and PTSD following trauma exposure, may have a detrimental impact on parenting quality and subsequent early child relationship formations. This review paper summarizes the literature on the role of sensitive parenting and a healthy mother–infant relationship in establishing a secure mother–infant attachment bond, which in turn is critical for the child’s healthy socioemotional and cognitive development. The review also highlights the roles of maternal perinatal depression, PTSD, and/or exposure to interpersonal violence or childhood maltreatment onto parenting, bonding, and child attachment style towards the caregiver. The final section discusses existing therapeutic interventions and approaches that bolster early parenting practices and early maternal–child relationships. Specific emphasis is placed on relational interventions that address bonding and attachment disturbances in the context of maternal perinatal mental health risk and trauma.     

Childhood trauma and obsessive-compulsive symptoms

Childhood trauma is known to predispose to a variety of psychiatric disorders, including mood, anxiety, eating, and personality disorders. However, the relationship between childhood trauma and obsessive-compulsive symptoms has not been well studied. This study examines the relationship between childhood trauma, personality facets, and obsessive-compulsive symptoms in 938 college students using the Childhood Trauma Questionnaire, the Leyton Obsessional Inventory, and the NEO Personality Inventory-Revised. Between 13 and 30% of subjects met criteria for childhood trauma, with emotional neglect the most commonly reported experience. There was a small but significant association between obsessive-compulsive symptoms and childhood trauma, specifically emotional abuse and physical neglect, all of which was accounted for by co-occurring anxiety symptoms. An independent association was also seen between emotional abuse, physical abuse, and high levels of obsessive-compulsive symptoms ("probable obsessive-compulsive disorder"), which remained significant in the context of co-occurring anxiety symptoms. A similar association was seen between obsessive-compulsive symptoms and conscientiousness, and between emotional neglect and sexual abuse and conscientiousness, suggesting that an indirect role for childhood trauma in the development of obsessive-compulsive symptoms may also exist.     

The Reciprocal Relationship of ASD,ADHD, Depressive Symptoms and Stress in Parents of Children with ASD and/or ADHD

This study investigated the role of parental Autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and depressive symptoms on parenting stress in 174 families with children with ASD and/or ADHD, using generalized linear models and structural equation models. Fathers and mothers reported more stress when parenting with their child with ASD and/or ADHD than when parenting with the unaffected sibling; they also experienced more stress than a norm population. Depressive symptoms were most pronounced in the parents of children with ASD and ASD+ADHD. Spouse correlations were found for ASD, depression, and parenting stress. Paternal ASD and maternal ADHD symptoms were related to increased parenting stress, and parental ADHD symptoms with depressive symptoms and parenting stress. The results highlight the increased burden of raising a child with ASD and/or ADHD and the reciprocal relationship this has with parents’ ASD, ADHD, and depressive symptoms, and levels of stress.     

Predictors and profiles of treatment non-adherence and engagement in services problems in early psychosis

Treatment adherence in early psychosis individuals is considered problematic. Some studies have tried to understand reasons for medication non-adherence in this population, though few have also considered engagement in services. We conducted a cross-sectional study with 118 early psychosis individuals, assessing multiple constructs (symptoms, insight, personality traits, alliance, childhood trauma, substance abuse, social functioning and sociodemographics) suggested in the literature as potentially linked to medication adherence or engagement in services. Forward Wald logistic regression suggested that more positive symptoms, having witnessed violence as a child and high agreeableness as a personality trait predicted poor medication adherence. Forward linear regression revealed that physical abuse as a child, lack of knowledge regarding consumer rights, difficulties in building an alliance, low neuroticism and high agreeableness predicted poor service engagement. Profiles of non-adherers or low service engagement were strongly linked to childhood trauma, and high agreeableness, as well as more severe symptoms and poor alliance. Males with histories of legal problems were also more prevalent in both groups. No significant differences were found for insight or substance abuse. Overall, individuals with early psychosis who adhered less to treatment in general could have issues with trusting authority and place more importance on peer acceptance. Results are presented in light of the existing literature and clinical implications are discussed.     

Dissociation and childhood trauma in psychologically disturbed adolescents

OBJECTIVE: To test the hypothesis that dissociation in adolescence is positively correlated with stress or abuse experienced earlier, the authors assessed dissociation in a heterogeneous group of disturbed adolescents and examined the relationship between the degree of dissociation and the degree of reported childhood stress, abuse, or trauma. METHOD: The subjects were 47 adolescents, 13-17 years old, who were institutionalized for periods of 1-13 weeks in a private mental hospital; 35 were girls and 12 were boys. Participants completed the Dissociative Experiences Scale and a child abuse and trauma questionnaire. The hospital records of 40 of the 47 adolescents were also available. RESULTS: Scores on the Dissociative Experiences Scale correlated significantly with self-reported physical abuse or punishment, sexual abuse, psychological abuse, neglect, and negative home atmosphere but not with abuse ratings made from hospital records. CONCLUSIONS: Together with the authors' previous work showing a relation between childhood stress and later dissociation in normal college students, these findings support the view that dissociation represents a reaction to early negative experience and places multiple personality disorder at the extreme end of a continuum of dissociative sequelae of childhood trauma. Researchers should continue to try to identify psychiatric patients with prominent dissociative characteristics or symptoms and attempt to correlate this phenomenology with negative earlier experiences.     

Insight into mental illness and child maltreatment risk among mothers with major psychiatric disorders

OBJECTIVES: This study examined the relationship between insight into mental illness and current child maltreatment risk among mothers who had a major psychiatric disorder and who had lost custody of a child because of abuse, neglect, or having placed the child at risk of harm. Specifically, a measure of insight was examined in relation to systematically observed parenting behaviors known to be correlated with past child maltreatment and in relation to a comprehensive clinical determination of risk. METHODS: Forty-four mothers who had a major psychiatric disorder were independently rated for their insight into their illness, the quality of mother-child interaction, and the overall clinical risk of maltreatment. RESULTS: Better insight into mental illness was associated with more sensitive mothering behavior and with lower assessed clinical risk of maltreatment. The association remained when mothers with current psychotic symptoms were excluded from the analyses. Better insight did not appear to be associated with past psychotic symptoms, maternal psychiatric diagnosis, or the mother's level of education. CONCLUSIONS: Insight into mental illness may function as a protective factor that influences the risk of child maltreatment in mothers with mental illness. Measures of insight could be usefully incorporated into comprehensive parenting assessments for mothers with psychiatric disorders.     

THIS ARTICLE HAS BEEN RETRACTED Measurement of Parenting Intention,Decision‐Making,and Expectations

PURPOSE. This article described the field‐testing of the 28‐item Parenting Paradigms Scale, a measure of adults' intentions and behavioral assumptions related to parenting and parenthood. DESIGN AND METHODS. Three parent groups developed prospective items describing parenting attitudes and expectations that reflected the four constructs of Aizen's Theory of Planned Behavior, a theoretical framework for predicting behavior. FINDINGS. The resulting Parenting Paradigms Scale was reviewed for content validity, was pilot tested, and was administered to 340 lesbian and gay adults 18–72 years of age who were parents to at least one child younger than 18 years old at the time of assessment. PRACTICE IMPLICATIONS. The Parenting Paradigms Scale measure demonstrated reliability and validity as a measure of social norms, assumptions, and expectations regarding parenting or planned parenting.     

Predicting maternal parenting stress in middle childhood: the roles of child intellectual status, behaviour problems and social skills

Background Parents of children with intellectual disabilities (ID) typically report elevated levels of parenting stress, and child behaviour problems are a strong predictor of heightened parenting stress. Interestingly, few studies have examined child characteristics beyond behaviour problems that may also contribute to parenting stress. The present longitudinal study examined the contribution of child social skills to maternal parenting stress across middle childhood, as well as the direction of the relationship between child social skills and parenting stress. Method Families of children with ID (n = 74) or typical development (TD) (n = 115) participated over a 2‐year period. Maternal parenting stress, child behaviour problems and child social skills were assessed at child ages six and eight. Results Child social skills accounted for unique variance in maternal parenting stress above and beyond child intellectual status and child behaviour problems. As the children matured, there was a significant interaction between child social skills and behaviour problems in predicting parenting stress. With respect to the direction of these effects, a cross‐lagged panel analysis indicated that early parenting stress contributed to later social skills difficulties for children, but the path from children's early social skills to later parenting stress was not supported, once child behaviour problems and intellectual status were accounted for. Conclusion When examining parenting stress, child social skills are an important variable to consider, especially in the context of child behaviour problems. Early parenting stress predicted child social skills difficulties over time, highlighting parenting stress as a key target for intervention.     

Assessment of Relevant Parenting Factors in Families of Clinically Anxious Children: The Family Assessment Clinician-Rated Interview (FACI)

Objective Research on child and adolescent anxiety disorders has seen a surge in investigations of parenting factors potentially associated with their etiology. However, many of the well-established parenting measures are limited by over-reliance on self-report or lengthy behavioral observation procedures. Such measures may not assess factors most salient to anxiety etiology, since most family functioning measures were not originally developed for this purpose. The Family Assessment Clinician Interview (FACI) was developed as a clinician-administered interview of parent and family factors associated with child and adolescent anxiety. The present study is the first to investigate the psychometric properties of the FACI. Method Using a clinical sample of 65 children with various anxiety disorders, and their parents, inter-rater reliability, convergent validity and associations with child-reported and clinician-evaluated anxiety severity were examined. Results suggest that the FACI has good to excellent inter-rater reliability with kappas ranging from 0.79 to 1.0 across FACI scales and subscales. Some evidence of convergent validity with relevant portions of the Family Environment Scale was observed, although the latter findings varied by respondent (mother versus father). The Family Warmth/Closeness subscale of the FACI was consistently associated with increased child anxiety symptoms. Contrary to expectations, higher levels of parental expectations were associated with lower levels of child anxiety. Conclusion Results suggest that the FACI is a promising measure of family anxiety constructs that may be useful in both research and clinical settings.     

Differential effects of childhood abuse and neglect: mediation by posttraumatic distress in neurotic disorder and negative symptoms in schizophrenia?

Dissociation, though understood as a response to trauma, lacks a proven etiology. The assumption of a dose-response relationship between trauma, dissociation and Schneiderian symptoms led to the proposal of a dissociative subtype of schizophrenia characterized by severe child maltreatment, dissociation and psychosis. Child maltreatment and dissociation are common features of neurotic disorders as well, and the link between trauma, dissociation, and hallucinations is not specific for schizophrenia. This study compares childhood abuse and neglect, posttraumatic distress and adult dissociation in patients with psychotic vs. non-psychotic disorder. Thirty-five participants with non-psychotic disorder and twenty-five with schizophrenia were analyzed using the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Montgomery-Åsberg Depression Rating Scale (MADRS), the Posttraumatic Stress Diagnostic Scale PDS (PDS), the Childhood Trauma Questionnaire (CTO) and the Arbeitsgemeinschaft Methodik und Dokumentation in der Psychiatrie (AMDP)-module on dissociation. Trauma and clinical syndromes were compared by means of T-testing and logistic regression between 1) the diagnoses and 2) groups with and without post-traumatic stress disorder (PTSD), marked dissociation and psychotic symptoms. While non-psychotic disorder was related to abuse, schizophrenia showed an association with neglect. Childhood trauma predicted posttraumatic symptomatology and negative symptoms. Childhood abuse and neglect may effectuate different outcomes in neurotic and psychotic disorder. The underlying mechanisms, including dissociation, dovetail with cognitive, emotional and behavioural changes involved in depression, posttraumatic distress and chronic schizophrenia symptoms rather than being directly linked to trauma.     

Parenting in families with a child with autism spectrum disorder and a typically developing child: Mothers’ experiences and cognitions

The parenting experiences of mothers in a family with a child with autism spectrum disorder (ASD) and a typically developing (TD) child were studied using a qualitative analysis of mothers’ perceptions of the impact of autism on family and personal life. An additional quantitative comparison was performed to evaluate the effect of ASD on mothers’ parenting cognitions about their other, TD child. Mothers differentiated clearly in parenting cognitions about their child with ASD and about their TD child. Strong associations were found between mothers’ symptoms of stress and depression, and their parenting cognitions about both their children. To maximize intervention outcome, family interventionists should consider parenting experiences and should become aware of interfering maternal feelings and cognitions, such as guilt or low parental self-efficacy beliefs.     

Is developmental timing of trauma exposure associated with depressive and post-traumatic stress disorder symptoms in adulthood?

BackgroundTrauma exposure is a known risk factor for psychopathology. However, the impact of the developmental timing of exposure remains unclear. This study examined the effect of age at first trauma exposure on levels of adult depressive and posttraumatic stress disorder (PTSD) symptoms.MethodsLifetime trauma exposure (including age at first exposure and frequency), current psychiatric symptoms, and sociodemographic information were collected during interviews with adults participating in a study at a public urban hospital in Atlanta, GA. Multiple linear regression models assessed the association between timing of first trauma exposure, classified as early childhood (ages 0–5), middle childhood (ages 6–10), adolescence (ages 11–18), and adulthood (ages 19+), on adult psychopathology in 2892 individuals.ResultsParticipants exposed to trauma (i.e., child maltreatment, other interpersonal violence, non-interpersonal violence, and other events) at any age had higher depressive and PTSD symptoms compared to their unexposed peers. However, participants first exposed to child maltreatment during early childhood had depression and PTSD symptoms that were about twice as high as those exposed during later developmental stages. This association was detected even after controlling for sociodemographic characteristics, exposure to other trauma types, and frequency of exposure. Participants first exposed during middle childhood to other interpersonal violence also had depressive symptoms scores that were about twice as high as those first exposed during adulthood.ConclusionsTrauma exposure at different ages may differentially impact depressive and PTSD symptoms in adulthood. More detailed examination of timing of trauma exposure is warranted to aid in identifying sensitive periods in development.     

Coparenting Competence in Parents of Children with ASD: A Marker of Coparenting Quality

The coparenting relationship has been linked to parenting stress, parenting self-efficacy and many other concerns associated with the development of children with ASD. Parents of children with ASD (N?=?22) were interviewed to explore three domains of their coparenting relationship; (1) adaptation to the emergence of their child’s autism, (2) parenting their child with ASD, (3) expectations for their child’s developmental outcomes. The concept of coparenting competence, developed during analysis, describes collective perceptions of parenting efficacy. Parents linked perceptions of coparenting competence to their, ability to cope with diagnosis and parenting, motivation to do what they could for their child, and hopes for their child’s development. The concept of coparenting competence could play an important role in future research and intervention.     

Preschool Children with and without Developmental Delay: Risk, Parenting, and Child Demandingess

Although past literature has established relations between early child risk factors, negative parenting, and problematic child behavior, the nature of these interrelations and pathways of influence over time remains largely unknown, especially in children with developmental delays or disabilities. In the current study data were drawn from the longitudinal Collaborative Family Study and included a sample of 260 families with preschool children with and without developmental delays. Child-related risk was assessed at child age 36 months, maternal intrusiveness and negative affect at 48 months, and child demandingness at 60 months. Results indicated significant relations between early risk, negative parenting, and subsequent child demandingness. Sickliness as an infant was the most salient predictive risk factor of later child demandingness. Developmental delay was the most significant predictor of subsequent negative parenting. Results are discussed as being more indicative of additive rather than mediational processes given that early child risk and negative maternal parenting both contributed uniquely to the subsequent development of child demandingness.     

A possible contra-indication for early diagnosis of Autistic Spectrum Conditions: Impact on parenting stress

The current study investigated the impact of diagnosis of Autistic Spectrum Conditions (ASCs) in children on parenting stress. While there is increasing pressure to provide early diagnosis of ASC, there is a lack of evidence relating to the impact of early diagnosis on the parents. The parents of 85 children with ASC completed measures of their parenting stress, and gave a brief history of their child and their diagnosis. The children were assessed for autistic severity and behavioral functioning. Autistic severity predicted their parents’ first noticing a problem, and the speed of the latter, rather than the child's autistic severity, predicted obtaining an earlier diagnosis. The autistic severity of a child was related directly to parenting stress. However, earlier diagnosis may be detrimental to levels of parenting stress. While parenting stress declined over time from the point at which the parents had first noticed a problem in their child, it failed to change by any significant degree once the diagnosis of ASC had been received. Given this possible contra-indication for early diagnosis of ASC, it warrants caution and further investigation.     

Childhood Predictors of Young Adult Social Functioning in 22q11.2 Deletion Syndrome

The primary objectives of the current prospective longitudinal study were to (a) describe social functioning outcomes and (b) identify childhood predictors of social functioning in young adults with 22q11.2 deletion syndrome (22q11.2DS). Childhood predictors of young adult social functioning were examined. Family environment and parental stress in adolescence were investigated as potential mediators between childhood variables and adult social functioning. Parent rated childhood internalizing symptoms significantly predicted young adult social functioning in 22q11.2DS, even after controlling for concurrent positive symptoms of psychosis, and problem behaviors contributing to parenting stress in adolescence partially mediated this relationship. These findings highlight child internalizing symptoms and adolescent problem behaviors as potential targets for social functioning interventions in 22q11.2DS.