Associations between parent–child relationship, and children’s externalizing and internalizing symptoms, and lifestyle behaviors in China during the COVID-19 epidemic

To investigate associations between parent–child relationships, children’s externalizing and internalizing symptoms, and lifestyle responses to the COVID-19 epidemic, we conducted an online survey of a random, representative sample of residents with children aged 3–17 years during mid-March 2020 in Wuhan and Shanghai, China. A total of 1655 parents and children were surveyed with a response rate of 80.1% in the survey. During the epidemic, the frequency of children enquiring about the epidemic (AOR = 1.46, 95% CI: 1.04, 2.06), parents explaining the epidemic to them (AOR = 2.87, 95% CI: 1.80, 4.58), parents expressing negative emotions in front of them (AOR = 2.62; 95% CI = 2.08–3.30), and parents with more irritable attitudes (AOR = 1.93; 95% CI = 1.33–2.81) were significantly associated with children’s externalizing symptoms. For internalizing symptoms, significant associations were found with worse parent–child closeness (AOR = 2.93; 95% CI = 1.80–4.79), the frequency of parents expressing negative emotions in front of them (AOR = 2.64; 95% CI = 1.68, 4.12), and more irritable attitudes (AOR = 2.24; 95% CI = 1.42–3.55). We also found that each indicator of parent–child relationships had the significantly similar associations with children’s lifestyle behaviors. These findings suggest that improving parents’ attitudes towards their children and parent–child closeness during the epidemic, especially among parents with lower educational levels, are important to ensure the wellbeing of children.

The Effect of Smoking during Pregnancy on Severity and Directionality of Externalizing and Internalizing Symptoms: A Genetically Informed Approach

The objective was to examine the association between maternal smoking during pregnancy (SDP) and (I) severity and (II) directionality of externalizing and internalizing symptoms in a sample of sibling pairs while rigorously controlling for familial confounds. The Missouri Mothers and Their Children Study is a family study (N = 173 families) with sibling pairs (aged 7 to 16 years) who are discordant for exposure to SDP. This sibling comparison study is designed to disentangle the effects of SDP from familial confounds. An SDP severity score was created for each child using a combination of SDP indicators (timing, duration, and amount). Principal component analysis of externalizing and internalizing behavior, assessed with the Child Behavior Checklist and Teacher Report Form, was used to create symptom severity and directionality scores. The variance in severity and directionality scores was primarily a function of differences between siblings (71% and 85%, respectively) rather than differences across families (29% and 15%, respectively). The severity score that combines externalizing and internalizing symptom severity was not associated with SDP. However, a significant within-family effect of SDP on symptom directionality (b = 0.07, p = 0.04) was observed in the sibling comparison model. The positive directionality score indicates that SDP is associated with differentiation of symptoms towards externalizing rather than internalizing symptoms after controlling for familial confounds with a sibling comparison model. This supports a potentially causal relationship between SDP and externalizing behavior.

Longitudinal associations between inhibitory control and externalizing and internalizing symptoms in school-aged children

Inhibitory control (IC) deficits have been associated with psychiatric symptoms in all ages. However, longitudinal studies testing the direction of the associations in childhood are scarce. We used a sample of 2,874 children (7 to 9 years old) to test the following three hypotheses: (a) IC deficits are an underlying risk factor with a potentially causal role for psychopathology, (b) IC deficits are a complication of psychopathology, and (c) IC deficits and psychopathology are associated at the trait level but not necessarily causally related. We used the go/no-go task to assess IC, the parent-rated Strengths and Difficulties Questionnaire to evaluate externalizing/internalizing symptoms, and the random intercepts cross-lagged panel model to test the hypotheses. The results showed no support for the underlying risk factor hypothesis, suggesting that IC unlikely has a causal role in this age group's psychopathology. The complication hypothesis received support for externalizing symptoms, suggesting that externalizing symptoms may hamper the normal development of IC. IC deficits and both externalizing and internalizing symptoms were correlated at the trait level, indicating a possible common origin. We suggest that it may be useful to support children with externalizing symptoms to promote and protect their IC development.

Training parents to adolescents' challenges: The CONNECT parent program

Adolescents' challenges could be effectively addressed by treating their parents. Prior evaluations of CONNECT, an attachment-based program intervention for parents of adolescents at risk, indicated that improving parenting skills and the quality of parent-adolescent relationship may result in decrease of adolescents' behavioural problems. The present study is part of a longitudinal research involving three Italian centres (Pavia, Milan, Pisa) aimed at investigating whether helping parents reduce their reliance on coercive or unproductive parenting strategies and understand changes occurring during adolescence from an attachment-based perspective would reduce their adolescents' externalizing and internalizing symptoms. One-hundred and eighteen parents of adolescents (Mage = 15.26 years, SD = 1.49; 64% boys), randomly assigned to the intervention group (n = 66) or to the wait-list control group (n = 52), reported on their perceptions of their adolescents' externalizing and internalizing symptoms (using the Strength and Difficulties Questionnaire-parent version; Goodman, 1997), as well as attachment avoidance and attachment anxiety (using the Adolescent Attachment Anxiety & Avoidance Inventory; Moretti and Obsuth, 2009) prior to treatment (t0), within a two-week period following the final treatment session (t1) and at a four months follow-up (t2). Parents attending the CONNECT program reported significant reductions in their adolescents' externalizing symptoms, and slightly significant reductions in their adolescents' internalizing symptoms by a reduction of anxiety and avoidance attachment strategies. The findings add evidence to the importance of investigating mechanisms of change underlying the effectiveness of CONNECT program, providing further indications on its application in therapeutic contexts.