Family Foundations effects during a pandemic: 10 year follow-up

As the COVID-19 pandemic has been highly stressful for parents and children, it is clear that strategies that promote long-term family resilience are needed to protect families in future crises. One such strategy, the Family Foundations program, is focused on promoting supportive coparenting at the transition to parenthood. In a randomized trial, we tested the long-term intervention effects of Family Foundations on parent, child, and family wellbeing one to two months after the imposition of a national shelter-in-place public health intervention in 2020. We used regression models to test intervention impact on outcomes reported on by parents in a standard questionnaire format and a series of 8 days of daily reports. We also tested moderation of intervention impact by parent depression and coparenting relationship quality. Relative to control families, intervention families demonstrated significantly lower levels of individual and family problems (general parent hostility, harsh and aggressive parenting, coparenting conflict, sibling relationship conflict, and children’s negative mood and behavior problems), and higher levels of positive family relationship quality (positive parenting, couple relationship quality, sibling relations, and family cohesion). For some outcomes, including coparenting conflict, harsh parenting, and child behavior problems, intervention effects were larger for more vulnerable families—that is, families with higher pre-pandemic levels of parent depression or lower levels of coparenting relationship quality. We conclude that targeted family prevention programming is able to promote healthy parent and child functioning during unforeseen future periods of acute stress. The long-term benefits of a universal approach to family support at the transition to parenthood indicate the need for greater investment in the dissemination of effective approaches.

Psychosocial Moderators and Outcomes of a Randomized Effectiveness Trial for Child Asthma

Objective Psychosocial factors play a role in child asthma morbidity and disparities, but their impact on asthma intervention effectiveness is less understood. This study examined how child, parent, and family psychosocial factors moderated asthma response to, and changed in response to, 2 community asthma interventions among urban minority youth. Methods Asthma Action at Erie was a randomized comparative effectiveness trial examining a community health worker (CHW) home intervention versus certified asthma educator (AE-C) services for children aged 5–16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was assessed via the Asthma Control Test (ACT)/childhood ACT and activity limitation. Baseline child/parent depression and posttraumatic stress disorder (PTSD) symptoms, family chaos, and social support were examined as treatment moderators. We also tested intervention effects on psychosocial outcomes. Results For parents with higher baseline depression symptoms, youth in the CHW group had greater ACT improvement by 24 months (7.49 points) versus AE-C (4.76 points) and 51% reduction in days of limitation by 6 months versus AE-C (ß = −0.118; p = .0145). For higher parent PTSD symptoms, youth in CHW had 68% fewer days of limitation at 24 months versus AE-C (ß = −0.091; p = .0102). Psychosocial outcomes did not vary by group, but parent depression, parent and child PTSD symptoms, and social support improved for all. Conclusions CHW intervention was associated with improved asthma control among families with higher parent strain. Findings have implications for utilizing tailored CHW home interventions to optimize asthma outcomes in at-risk families.

Parenting and child and adolescent mental health during the COVID-19 pandemic

Background: Early work indicates the significant impact of the COVID-19 pandemic on the mental health of children and adolescents. Understanding which children may be more at risk for mental health problems, and which risk factors are amenable to change is crucial. The importance of studying children’s mental health within the context of the family system is recognized. Methods: The current study investigated associations between parent factors, and children’s mental health during the early phase of the COVID-19 pandemic across a number of Western countries (primarily Australia and the United Kingdom). Parents (N = 385) reported on their pandemic-related stress, mental health, and parenting behaviors, in addition to mental health changes in their 5-17 year old children (N = 481) during April/May 2020. Results: Analyses revealed significant associations between parent COVID-19 pandemic stress, parent depression, anxiety and stress symptoms, and increases in child internalizing and externalizing problems. Harsh parenting behavior was associated with trauma symptoms and increases in externalizing problems. Further, some associations were more pronounced for children with existing mental health problems, and for disadvantaged and single parent families. Limitations: The data was cross-sectional, the majority of participant parents were female, and all data were parent-report. Conclusions: Findings suggest the importance of parents in influencing children’s mental health during the acute phase of the COVID-19 pandemic. Further work is needed to investigate longer-term impacts.

Maternal Depression: Relationship to Food Insecurity and Preschooler Fruit/Vegetable Consumption

Background: Maternal Depression (MD) has been implicated in the etiology of obesity. The present study investigated MD and both child fruit/vegetable consumption (FVC) and household food insecurity (FI) in an early childhood population. Methods: This cross-sectional study was conducted in Arkansas, United States, in 26 Head Start centers. Teachers obtained the Family Map (FM), an interview assessment tool used by Head Start staff to identify potential risk factors that affect child learning and development. The FM contains a two-item screener of parent depression—the Patient Health Questionaire-2, two questions about family FI, and two questions about FVC. The FM was completed in 693 households. Chi square analyses and logistic regressions utilizing adjusted and unadjusted odds ratios were utilized to compare differences in risk for children of mothers with no symptoms compared to mothers with low- or high-level depressive symptoms. Results: Children whose mothers had high MD were 2.90 (CI: 1.21–7.00) and 7.81 (CI: 3.71–16.45) times more likely to be at risk for low FVC and FI, respectively, compared to children of mothers with no MD. Similar findings but at lower magnitude were found for mothers with low symptoms of MD in comparison with mothers with no MD—both for Low FVC (1.57 times more likely; CI: 1.01–2.45) and FI (2.14 times more likely; CI: 1.28–3.58). The results presented are Odds Ratios from the multivariable adjusted models. Conclusions: Implications for the etiology of obesity, prevention/intervention efforts, and future research are offered, including recommended addition of maternal depression and household FI screening in early childhood programs.

Routine Psychological Screening for Parent Depressive Symptoms in an Outpatient Pediatric Specialty Burn Clinic

Pediatric burn injuries are stressful for parents, yet few burn clinics report screening caregivers. We evaluated psychometric properties of a two-item depression screener administered to parents of children with burns during outpatient clinic visits. We also examined associations between parent depression symptoms and child characteristics. We used a retrospective review of pediatric patients with burn injuries (n = 496, age range: 0–21 years; M = 5.0 years, SD = 4.4 years) from an outpatient specialty burn clinic. Sample was 54.8% male; ethnicity was 42.4% Black/African American and 42.2% White. Most children (94.7%) had a burn TBSA of 10% or less and partial thickness burns (87%). Depression measure was administered at two time points as part of routine care: T1 (n = 496) and T2 (n = 121). Score range was 0 to 8. The means were 1.17 (SD = 1.74) at T1 and 0.81 (SD = 1.40) at T2. The majority scored ≤3 (89.9% caregivers) at T1. The measure demonstrated satisfactory internal consistency at T1 (Cronbach α = .74) and T2 (α = .82). Scores at T1 and T2 for a subsample (n = 121) were related (r = .61, p < .001). Parents of non-White children tended to report higher depression scores at T1. At T2, being female and greater burn degree were associated with higher depression scores. This brief two-item scale used with caregivers of pediatric burn patients is a reasonable method for screening parental depression in this setting. Given the association between parental depression and child characteristics, further studies are needed, including examination of predictive validity of parental depression with pediatric outcomes.

Parent Psychopathology and Neurocognitive Functioning in Children With ADHD

Objective: The objective of this study was to examine the association between parent mental health (ADHD and depression) and offspring performance on neurocognitive tasks in children with ADHD. Method: The clinical sample consisted of 570 children (85% males, mean age: 10.77 years) with ADHD who completed neurocognitive tasks measuring working memory, attention set-shifting, and motivational deficits. Questionnaire measures were used to assess ADHD and depression symptom presence in parents. Results: Controlling for ADHD severity, children of parents with ADHD had poorer working memory ( B = −0.25, 95% confidence interval [CI] [−0.45, −0.07], p = .01) and increased errors on the extra dimensional shift stage of the set-shifting task ( B = 0.26 95% CI [0.02, 0.50], p = .04). Parent depression was not associated with offspring performance on any of the assessed neurocognitive tasks. Conclusion: Children with ADHD who have a parent with ADHD symptom presence are a subgroup of children who may have additional neurocognitive impairments that have potential implications when implementing interventions that target cognition and learning.