The effect of physical activity on quality of life and parenting stress in children with attention-deficit/hyperactivity disorder: A randomized controlled trial

BackgroundPoorer quality of life (QoL) is commonly observed in children with Attention-deficit/Hyperactivity Disorder (ADHD). Parents of children with ADHD also perceived elevated levels of parenting stress. Previous research has documented the positive effects of physical activity (PA) on managing ADHD symptoms. It is critical to implement ADHD management with broader functioning from both children's and parents' perspectives.ObjectiveThis study aimed to examine whether PA would exert an influence on the QoL of children with ADHD and parenting stress of their parents.MethodsForty-three children with ADHD (6–12 years) were randomly assigned to the PA intervention and waitlist control groups. Children in the intervention group participated in a 12-week PA program. Parent-reported QoL and parenting stress were assessed before and immediately after the intervention. Analysis of covariance with a mixed factorial design of 2 (time: before vs. after intervention) × 2 (group: PA intervention vs. waitlist control) was conducted to examine changes in QoL and parenting stress over the 12 weeks.ResultsCompared to the control group, parents of children in the intervention group reported significant reduced overall parenting stress (p = .021, η² = 0.142) and child domain of parenting stress (p = .024, η² = 0.138) after the intervention. No significant improvement in QoL was documented in either group.ConclusionsThe participation of PA intervention positively impacts parenting stress perceived by parents of children with ADHD, which provides further evidence of the family-wide benefits of the PA intervention.     

Disentangling Associations of Children's Sports Participation and Compulsive Exercise With Parenting Practices and Child Disordered Eating Behavior

PurposeExercise can enhance health and well-being. Exercise can also, when it is highly driven and compulsive, reflect eating disorder psychopathology. The present study examined associations of compulsive exercise and youth athletics with child disordered eating behaviors (overeating, binge eating, and secretive eating) and with parenting practices related to eating and weight, including how parents talk to their children about weight.MethodsParticipants were parents (N = 875) who completed an online cross-sectional survey. Parents reported whether their child was an athlete and how often their child exercised in a “driven” or “compulsive” way to control their weight. Four groups were compared: child athletes with compulsive exercise (Group AE: n = 34, 3.9%), athletes without compulsive exercise (Group A: n = 314, 35.9%), nonathletes with compulsive exercise (Group E: n = 40, 4.6%), and nonathletes without compulsive exercise (Group X: n = 487, 55.7%).ResultsThere was a significant, graded association of eating/weight-related parenting: parents of Group E children had the most negative eating/weight-related parenting, followed by parents of Group AE children, followed by both noncompulsive exercise groups (Group A and Group X). Parents reported significantly more “fat talk” in both compulsive exercise groups (Group AE and Group E) than noncompulsive exercise groups (Group A and Group X). Significantly more youth had regular disordered eating behaviors (overeating, binge eating, and secretive eating) in compulsive exercise groups (Group AE and Group E) compared with noncompulsive exercise groups (Group A and Group X).ConclusionsOverall, relatively few youth were categorized as engaging in compulsive exercise. However, compulsive exercise, particularly among nonathletes, was consistently associated with both disordered eating behaviors and eating/weight-related parenting practices. Stronger associations emerged for compulsive exercise than child athletics.     

Pathways of influence: Chinese parents' expectations,parenting styles,and child social competence

This study examines relations among Chinese parents' expectations for children's development of social–emotional skills, parenting styles, and child social competence. A total of 154 parents with preschool-aged children from mainland China completed questionnaires measuring their timing of expectations for children's mastery of social–emotional skills, value placed on social–emotional skills, parenting styles, and child social competence. Parenting styles were found to mediate the effects of parental expectations on child social competence. Parents with earlier expectations reported higher levels of authoritative parenting, which, in turn, related to better parent-reported child social competence. Parents who placed more value on social–emotional skills were more likely to adopt an authoritative parenting style, and subsequently, they reported children having better social competence.     

Pediatric-Specific Parenting Stress and Family Functioning in Parents of Children Treated for Cancer

The association between pediatric parenting stress (i.e., parenting stress related to caring for a child with a medical illness) and family functioning outcomes was evaluated in 116 parents of children treated for cancer. Results indicated that pediatric parenting stress, as measured by the Pediatric Inventory for Parents (PIP), was significantly correlated with family functioning, using the McMaster Family Assessment Device (FAD). After controlling for child treatment status (on vs. off treatment), several independent associations among PIP and FAD scores emerged, indicating that increased pediatric parenting stress is associated with poorer family functioning outcomes. Findings, within the limitations of the study, suggest that pediatric parenting stress and family functioning are important constructs to assess when working with children who are being treated for cancer, and family-based interventions targeting the needs of this population may be warranted.     

Parent scaffolding of young children’s use of touch screen tablets

ABSTRACT

Parents play a key role in supporting young children’s interactions with tablets (e.g. iPads). Little is known about the types of scaffolding parents provide during tablet activities and how these relate to child age, SES, and home use. Fifty-five parent–child dyads (M child age?=?3.49 years) were videoed as they played on an iPad. All parent utterances were coded into three types of scaffolding behaviours (cognitive, affective, technical scaffolding; CATs). Home tablet use and family demographics were reported via a parent questionnaire. Parents used CATs strategies to support their children’s learning. Parents most frequently used cognitive scaffolding and least frequently technical scaffolding. SES was not related to the number of tablets at home. The negative association found between technical scaffolding and child age suggests that younger children require more scaffolding by parents. Coaching parents in using scaffolding strategies during joint-tablet activities has the potential to support early learning.     

Feeding Style Differences in Food Parenting Practices Associated With Fruit and Vegetable Intake in Children From Low-income Families

ObjectiveTo examine the moderating effects of feeding styles on the relationship between food parenting practices and fruit and vegetable (F & V) intake in low-income families with preschool-aged children.DesignFocus group meetings with Head Start parents were conducted by using the nominal group technique. Parents completed information on food parenting practices and feeding styles. Three dietary recalls were collected on each child.SettingParents completed measures in Head Start centers and/or over the telephone.Participants667 parents of preschool-aged children participated.OutcomesFood parenting practices and F & V intake.AnalysisMean differences in the food parenting practices across the 4 feeding styles were established through multivariate general linear modeling using MANOVA. Moderated multiple regression analysis was conducted to examine the moderating role of feeding style on food parenting practices and child F & V intake.ResultsThe indulgent feeding style moderated the relationship between food parenting practices and child F & V intake.Conclusions and ImplicationsThis study indicates that parents' feeding styles have a moderating effect on the relationship between the food parenting practices and children's F & V intake. This finding can facilitate the development of interventions aimed at reducing childhood overweight.     

The Association Between Overparenting,Parent‐Child Communication,and Entitlement and Adaptive Traits in Adult Children

What is colloquially referred to as “helicopter parenting” is a form of overparenting in which parents apply overly involved and developmentally inappropriate tactics to their children who are otherwise able to assume adult responsibilities and autonomy. Overparenting is hypothesized to be associated with dysfunctional family processes and negative child outcomes. Predictions were tested on 538 parent‐young adult child dyads from locations throughout most of the United States. Parents completed a newly developed measure of overparenting as well as family enmenshment, parenting styles, and parent‐child communication scales. Young adult children completed measures of parent‐child communication, family satisfaction, entitlement, and several adaptive traits. Results showed that overparenting is associated with lower quality parent‐child communication and has an indirect effect on lower family satisfaction. Overparenting was also a significant predictor of young adult child entitlement, although it was not related to any of the adaptive traits measured in young adult children.     

Mental health risks of parents of children with developmental disabilities: A nationally representative study in the United States

BackgroundCaring for a child with a developmental disability may affect parents’ mental health. There are few longitudinal or nationally representative studies, none on new mental health problems. Studies have few young children, and few adult children.Objective/hypothesesWe hypothesized that parents of children with developmental disability would be more likely to develop mental health problems than other parents.MethodsWe used the Panel Study of Income Dynamics (PSID, 1997–2017) and its Child Development Supplements, defining developmental disability by diagnoses such as autism spectrum disorder or intellectual disability, and requiring additional evidence of lasting impairment. We linked children’s and parents’ data spanning 20 years, including 44,264 mental health measurements for 4024 parents of 7030 children. Discrete-time hazard analysis controlled for child and parent characteristics.ResultsAbout 9.4% of children had developmental disability. Parents of children with developmental disability were more likely to develop mental health problems than other parents. The odds of developing anxiety or depression were higher when an adult child with developmental disability lived independently, nearly 3 times higher for mothers (OR 2.89, CI 2.33–3.59) and more than twice as large for fathers (OR 2.35, CI 1.70–3.26). Compared to fathers whose children did not have developmental disability and challenging behaviors, the odds of psychological distress were over 7 times larger (odds ratio, OR 7.18, 95% confidence interval, CI, 5.37–9.61) for those whose children had developmental disability and challenging behaviors.ConclusionsParents of children with developmental disability may benefit from increased emotional support, respite, and interventions addressing challenging behaviors.     

Trajectories of Stress among Parents of Children with Disabilities: A Dyadic Analysis

Parents of children with developmental disabilities (DD) face greater caregiving demands than other parents, which may lead to heightened levels of stress. Characteristics of the child with DD as well as family resources may explain the extensive variability observed in parental adjustment. This study examined trajectories of parenting stress among 108 mother–father dyads parenting a child with DD, from early childhood (age 3) through adolescence (age 15). Using multilevel dyadic analyses, stress was found to increase from early to middle childhood then subsequently decrease through adolescence. Child‐related stressors (behavior problems, adaptive behavior) and family resources (social support, positive family climate) in early childhood predicted initial levels and change in stress. Mother–father differences and recommendations for intervention are discussed.     

Australian parents’ use of universal child and family health services: A consumer survey

This study aimed to explore Australian parents’ use of universally available well‐child health services. It used an online survey of 719 parents of children aged from birth to 5 years in all states and territories to examine patterns of service use and consumer preferences. In Australia, several health professional groups provide advice to pregnant women, infants, children, and parents, offering health promotion, developmental screening, parenting support, and referral to specialist health services if required. The survey examined parents’ use of different child and family health providers, and their preferences for support with several common parenting issues. The study indicated that families with young children obtain primary healthcare from a range of service providers, often more than one, depending on children's ages and needs. Parents frequently visit general practitioners for immunisation and medical concerns. They attend dedicated child and family health nurses for parenting advice and well‐child checks and prefer them as an information source for many health issues. However, a substantial proportion of parents (44.1%) do not currently visit a child and family health nurse, often because they not only do not perceive a need but also sometimes because these services are unknown, inaccessible, or considered unsuitable. They may seek advice from less qualified sources. There is potential for increased collaboration between child and family health providers to ensure effective resource use and consistency of parenting information and advice. Nursing services may need to address accessibility and appropriateness of care.     

High Parenting Aggravation Among US Immigrant Families

Objectives. We examined the association between the joint effects of children’s immigrant family type and race/ethnicity on parenting aggravation.Methods. We analyzed data on a nationally representative sample of 101 032 children aged birth through 17 years from the 2003 National Survey of Children’s Health.Results. Analysis of the Aggravation in Parenting Scale showed that 26% of foreign-born parents with foreign-born children were highly aggravated, followed by 22% of foreign-born parents with US-born children and 11% of US-born parents. Multivariable analyses indicated that all minority parents experienced high parenting aggravation compared with non-Hispanic White US-born parents; the odds of reporting parenting aggravation were 5 times higher for Hispanic foreign-born parents. All foreign-born parents, regardless of race/ethnicity, reported significantly elevated parenting aggravation. Parents of adolescents, children with special health care needs, and nontraditional and lower-income households were also more likely to report high parenting aggravation.Conclusions. Our findings clearly document significantly elevated levels of parenting aggravation among immigrant and minority families. Public health programs and clinicians should target referrals and interventions for these families to avoid potential health problems for both children and their families.Between 2000 and 2005, the United States saw the highest 5-year period of immigration in its history.1 Census data indicate that 22% of children, or 16 million, lived with a foreign-born householder in 2007, an increase from 12.1% from 1990, although only 4% of all US children were themselves foreign born.2 In 2005, an estimated 3.1 million children lived in “mixed-status” families that included both citizen and noncitizen members, making the children’s health care access and eligibility for public benefits more complex.3 Five out of 6 undocumented families with children are in this category. Children living with foreign-born householders tend to be younger, and are more likely to live in poverty than those living with US-born householders.4Regardless of nativity, children in immigrant families are a special population since their well-being is very much influenced by the immigrant attributes of their parents, including those related to language and culture, health care–seeking behavior, and public program access and eligibility.5–8 The notion of “immigrant family type” is therefore important in the study of family dynamics, representing different challenges faced by these families. Within the last decade, immigrants have also dispersed to many states that previously did not have a large foreign-born population and thus may lack the infrastructure and resources to address the special needs of such populations.9Among the many hardships faced by immigrant families, those related to economic conditions, health insurance, acculturation, access of public benefit programs, and English proficiency are likely the most challenging.10,11 These may all contribute to stress and aggravation in the family lives of immigrants. Raising children in a new country can be difficult. Immigrant parents are frequently limited in their ability to act as advocates for their children in the school and health care settings.12 On the other hand, the evidence of resilience and the academic and socioeconomic success of children from immigrant households has probably masked the hardships and demanding adjustments experienced by immigrant families.13–15Despite studies showing lower mortality and morbidity risks among immigrants compared with US-born infants, children, and adults,16–22 other measures of health and well-being, such as parent-reported health status, participation in physical activities, access to preventive services, and other psychosocial characteristics have been less favorable.23–26 The American Academy of Pediatrics recently updated its policy statement describing the unique and complex medical and psychosocial risks faced by immigrant children and recommended that children not be denied needed services on the basis of immigration status.27 Furthermore, the intended and unintended effects of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act8,28 have posed numerous challenges to health care access and the family lives of recent immigrants.29,30Parenting aggravation is a measurement of stress experienced by parents associated with caring for children. High parenting aggravation has previously been associated with maternal and paternal depression, autism, learning disabilities, child obesity, maternal chronic illness, paternal alcoholism, single parenthood, family transitions, and Black race.31–39 Parenting aggravation has never been explored in immigrant families and racial/ethnic groups.The 2003 National Survey of Children’s Health (NSCH) is the first national survey that provides information on parenting aggravation on a sufficiently large sample of children from different racial/ethnic groups and immigrant family types to permit such analysis.40 Using data from the 2003 NSCH, we aimed to determine the prevalence of parenting aggravation in different immigrant family types and racial/ethnic groups in the United States, and to examine the joint effects of race/ethnicity and immigrant family type on parenting aggravation while controlling for confounding variables. To our knowledge, our study is the first that characterizes parenting aggravation in immigrant families using a large nationally representative probability sample.     

Do Parents Perceive That Organized Activities Interfere with Family Meals? Associations between Parent Perceptions and Aspects of the Household Eating Environment

BackgroundResearch has related child participation in organized activities to health and academic benefits; however, participation may interfere with family meals.ObjectiveExamine whether parents perceive child participation in organized activities to interfere with family meals and how perceptions are related to the household eating environment.DesignA cross-sectional analysis was completed using survey data collected in 2015-2016 as part of the Project EAT (Eating and Activity in Teens and Young Adults) cohort study.ParticipantsSurvey participants were originally recruited in Minneapolis–St Paul schools in 1998-1999. The analytic subsample of parents (one per household, n=389, 69% female, 31% nonwhite race, mean age=31) had one or more children involved in an organized activity. Approximately 33% of households included a child aged 2 to 5 and no older child; two thirds of households included school-aged children (6 to 18 years).Main outcome measuresParents reported family meal frequency, family meal scheduling difficulties, frequency of at-home meal preparation, and their own intake of fast food, fruit, and vegetables.Statistical analyses performedAnalyses compared household environment characteristics reported by parents who perceived low interference between organized activities and family meals to characteristics reported by parents who perceived moderate to high interference from at least one form of activity. Regression models included a dichotomous indicator of interference as the independent variable and were adjusted for parental and household characteristics.ResultsAmong parents with children at any age, moderate to high interference was associated with lower family meal frequency, greater difficulty scheduling family meals, and more fast-food intake (all P≤0.01). The perception of moderate to high interference was more common among parents who reported involvement in both sport and nonsport activities (P<0.001) and those with a school-aged child (P<0.001) vs those with only preschool-aged children.ConclusionsFollow-up research, including qualitative studies, is needed to identify the specific aspects of child participation in organized activities (eg, scheduled time of day) that may interfere with family meals.     

Positive parenting support during family reunification

ABSTRACT

This article presents the results of a qualitative study that explores parenting skills when a child returns home after a period of foster care in the child protection system. There were a total of 135 participants, including 63 child protection professionals, 42 parents and 30 children and adolescents. The data were analysed using content analysis submitted to peer review. Triangulating the voices of children with the input of parents and professionals rendered it possible to identify needs for the consolidation of family reunification in five dimensions: adjustment of parenting skills, adaptation to the needs of the child, social support, more accurate perception of one’s role, and parental self-efficacy. These findings suggest particular characteristics in the development of both generally applicable skills and skills specific to positive parenting that can improve the chances of a successful reunification process.     

ENTREN-F family-system based intervention for managing childhood obesity: Study protocol for a randomized controlled trial at primary care

BackgroundPediatric obesity is a primary public health concern, and designing effective programs for managing it is of the utmost importance. The objective of this study was to describe the protocol study of a three-arm, parallel, randomized controlled trial aimed at assessing the efficacy of a family-system-based intervention (“ENTREN-F” program) for managing childhood obesity, compared to the “ENTREN” program (no “F” - without specific family-system-based workshop) and a control group (behavioral monitoring).Methods/designThe ENTREN-F program was a multicomponent family-system-based intervention carried out by a multidisciplinary team in the primary health care setting. The program targeted children between 8 and 12 years with overweight and obesity (P ≥ 85th). Parents were actively involved in the process. The contents were designed using the Cognitive Behavioral Therapy (CBT) principles. The program comprised individual behavioral monitoring, a healthy habits workshop for children and their parents, a CBT workshop for children, and a family-system-based workshop for parents, enhancing parental management skills plus family functioning. The trial’s primary outcomes included changes in child body mass index (BMI) z-scores, child’s psychological well-being, and family functioning over six months. Secondary outcomes included changes in eating behavior, physical activity, self-esteem, parental distress, parental feeding practices, and parental modeling.DiscussionTo our knowledge, this is one of the few randomized controlled trials to assess the efficacy of a multicomponent program that considers health from a comprehensive perspective, trying to improve children’s psychological well-being and family functioning besides weight loss. This study, therefore, addresses a gap in the literature. If found to be efficacious, it suggests a new potential health service for translation into National Primary Health Care services in Spain, one of the ten countries with the highest prevalence of obesity in Europe.     

Forgone vaccination during childhood and adolescence: Findings of a statewide survey of parents

ObjectiveWidespread immunization confers both individual- and community-level protection against vaccine-preventable diseases. To better understand vaccine hesitancy, we assessed correlates of forgone vaccination for children and adolescents.MethodWe analyzed weighted data from the 2010 Child Health Assessment and Monitoring Program survey of North Carolina parents (n = 1,847) of children ages 1–17.ResultsOverall, 12% of parents reported having refused or delayed a vaccine for their child. Forgone vaccination was more common for young children than for teenagers (16% versus 8%) and for children born before rather than on/after their due dates (16% versus 10%). Parents with high (versus low) scores on an index of healthy feeding practices were also more likely to report forgone vaccination (17% versus 5%). The most common reason for forgoing vaccines was concern about safety (34%). Other reasons included believing the child did not need (18%) or was too young (13%) for the vaccine, or that the child was sick (10%).ConclusionForgoing vaccines is more common among parents who are socially advantaged and highly attentive to their children's health in other areas such as nutrition. Providers should reassure parents of premature or sick children that such circumstances are not typically contraindications to vaccination.     

Using household survey data to inform policy decisions regarding the delivery of evidence-based parenting interventions

BACKGROUND: This study used household survey data on the prevalence of child, parent and family variables to establish potential targets for a population-level intervention to strengthen parenting skills in the community. The goals of the intervention include decreasing child conduct problems, increasing parental self-efficacy, use of positive parenting strategies, decreasing coercive parenting and increasing help-seeking, social support and participation in positive parenting programmes. METHODS: A total of 4010 parents with a child under the age of 12 years completed a statewide telephone survey on parenting. RESULTS: One in three parents reported that their child had a behavioural or emotional problem in the previous 6 months. Furthermore, 9% of children aged 2-12 years meet criteria for oppositional defiant disorder. Parents who reported their child's behaviour to be difficult were more likely to perceive parenting as a negative experience (i.e. demanding, stressful and depressing). Parents with greatest difficulties were mothers without partners and who had low levels of confidence in their parenting roles. About 20% of parents reported being stressed and 5% reported being depressed in the 2 weeks prior to the survey. Parents with personal adjustment problems had lower levels of parenting confidence and their child was more difficult to manage. Only one in four parents had participated in a parent education programme. CONCLUSIONS: Implications for the setting of population-level goals and targets for strengthening parenting skills are discussed.     

Parent Website Engagement and Health Equity Implications in a Child Care–Based Wellness Intervention

ObjectiveTo evaluate demographic differences in parent website engagement in a child care–based wellness intervention.DesignParent-reported demographic characteristics and observed website engagement were averaged by child care centers participating in the web-based intervention arm of a cluster randomized controlled trial of wellness interventions.Setting and ParticipantsParents of preschoolers in 17 Maryland child care centers.Main Outcome MeasuresWebsite engagement: (1) webpage views, (2) average time on webpage, and (3) intervention activity completion.InterventionParents received access to a website containing content on wellness-promoting topics (eg, parenting, nutrition, physical activity) and their child care center's activities.AnalysisCross-sectional differences in website engagement by demographic characteristics were assessed using ANOVA.ResultsCenters with a high proportion of parents who identified as other than non-Hispanic White and had less than a bachelor's degree had significantly fewer webpage views, and completed significantly fewer intervention activities compared with centers with parents who were predominantly non-Hispanic White and had more than a bachelor's degree.Conclusions and ImplicationsDemographic differences in parents’ child care center website engagement represent disparities that could contribute to health inequities in parents’ access to wellness-promoting material. Future efforts could identify factors that eliminate demographic disparities in parent engagement in web-based interventions.     

Family and Relationship Influences on Parenting Behaviors of Young Parents

PurposeAssess the influence of relationship and family factors during pregnancy on parenting behavior 6 months postpartum among low-income young parents.MethodsSome 434 young expectant couples were recruited from obstetrics clinics during pregnancy and followed 6 months postpartum. Using a series of general estimating equations to control for the correlated nature of the data, we assessed the influence of relationship factors (e.g., relationship satisfaction, attachment) and family factors (e.g., family functioning, family history) during pregnancy on parenting (e.g., parenting involvement, time spent caregiving, parenting experiences, and parenting sense of competence) 6 months postpartum controlling for covariates.ResultsRelationship functioning related to parenting involvement, caregiving, parenting experiences, and parenting sense of competence. In addition, several family factors related to parenting. Mother involvement during childhood was related to more parenting involvement, parenting positive experiences, and parenting sense of competence. History of being spanked as a child related to less time spent caregiving and less positive life change from being a parent. Further, gender significantly moderated the associations between relationship and family factors and parenting behavior. Male parenting behavior was more influenced by relationship and family factors than female parenting.ConclusionsThis study suggests the importance of relationship and family contexts for parenting behaviors of young mothers and fathers, highlighting the potential utility of involving both young mothers and fathers in parenting programs, and developing interventions that focus on strengthening young parents' romantic relationships and that address negative parenting experienced during childhood.