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Sleep Medicine Nov 2023Young children with autism spectrum disorder (autism) have bedtime and sleep disturbances at much higher frequency and persistency than their neurotypical counterparts.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND PURPOSE
Young children with autism spectrum disorder (autism) have bedtime and sleep disturbances at much higher frequency and persistency than their neurotypical counterparts. Hence, access to early, effective treatment is critical in view of the importance of sleep in early childhood. Telehealth delivery could be a means to expand access to such early treatment if efficacious. The aim of this randomized control trial (RCT) was to compare a manualized, telehealth delivered, behaviorally based sleep parent training (SPT) intervention for parents of young children with autism and sleep disturbances to a control condition, a telehealth delivered parent education program with one sleep focused session (SPE). We hypothesized that the SPT group would show more improvements on child measures of sleep outcome measures, and daytime behaviors and parent measures of stress and sense of competence. We further aimed to explore the overall feasibility of telehealth delivery of SPT and SPE.
PARTICIPANTS AND METHODS
Parents of 77 young children, ages 2-7 years, with autism and co-occurring sleep disturbances were enrolled in this study. Participants were randomized to either SPT or a comparison arm that included non-sleep related parent education except for one session. Each participant was individually administered a 5 session program delivered over 10 weeks. Outcome measures, including child sleep measures, child daytime behavior and parent stress and sense of competency were collected at weeks 5 and 10 after the baseline time point. Feasibility indicators (treatment fidelity, parent adherence, and parent attendance), and safety measures were also collected.
RESULTS
Of 77 randomized participants, data were available for 36 participants randomized to SPT and 38 participants randomized to SPE. The mean age was 3 years, 8 months. Results support the efficacy of this manualized SPT intervention for bedtime and sleep disturbances. Sleep outcome measures were significantly improved in the SPT group compared to SPE on the Modified Simonds & Parraga Sleep Questionnaire-Composite Sleep Index (MSPSQ - CSI) (p < 0.001) with a large effect size of 0.83 at week 10. Positive response to treatment, as determined from the Clinical Global Impression-Improvement scale (CGI-I) at week 10 was observed in 56% of SPT participants compared to 32% in SPE (p = 0.037). There were no significant group differences in either the ABC-I as measure of daytime behaviors or in parental stress. There were group differences in favor of SPT over SPE on the PSOC, a measure of parent sense of competency. Feasibility and safety were further demonstrated with telehealth delivery.
CONCLUSIONS
This RCT demonstrated the efficacy of a telehealth delivered parent training intervention for bedtime and sleep disturbances in young autistic children compared to an active control condition. Further, parents in SPT reported more confidence in their parenting role than those in the SPE group, but SPT did not result in overall decreases in parental stress. Telehealth delivery allowed for a much broader reach with enrolled participants from 24 states. This study supports a telehealth approach to a manualized behavioral parent mediated intervention for sleep disturbance in young autistic children and offers an alternative to in-person delivered approaches. This telehealth delivery has the potential to improve access for families who have a young autistic child with sleep disturbances. Given the small sample size, determining predictors and moderators of treatment response was not possible and should be examined in a larger trial.
Topics: Child, Preschool; Humans; Child; Autism Spectrum Disorder; Parents; Parenting; Sleep Wake Disorders; Telemedicine; Sleep
PubMed: 37806263
DOI: 10.1016/j.sleep.2023.08.033 -
Clinical Psychology Review Nov 2023There is a large evidence base supporting an important role of parenting behavior in influencing youth mental health; however, this literature often fails to capture the... (Meta-Analysis)
Meta-Analysis Review
There is a large evidence base supporting an important role of parenting behavior in influencing youth mental health; however, this literature often fails to capture the potentially unique and interactive role of mothers and fathers. This systematic review and meta-analysis aimed to investigate the role of maternal and paternal parenting behaviors in relation to child and adolescent internalizing problems. Following PRISMA (2020) guidelines, 88 studies were identified. Of these, 47 studies and upward of 65 parent-behavior and child-outcome combinations were examined. Findings indicated a unique role of maternal overprotection in the prediction of child anxiety symptoms. For other parenting behaviors, largely similar associations were found for maternal and paternal parenting behaviors with child and adolescent anxiety, depressive symptoms and broader internalizing problems. There was preliminary support for the interaction of maternal and paternal parenting being important in predicting youth symptoms. Although findings did not strongly substantiate differences in the effects of maternal and paternal parenting practices, with only one significant difference identified, further research would benefit from stronger representation of fathers, to enable a more rigorous and comprehensive understanding of each parent's role, and their interactive influence on internalizing outcomes of their children.
Topics: Male; Female; Humans; Adolescent; Parenting; Fathers; Mothers; Anxiety; Anxiety Disorders
PubMed: 37793269
DOI: 10.1016/j.cpr.2023.102339 -
Academic Pediatrics 2023Healthy parent-child relationships are clearly critical to healthy child development. Parenting programs develop caregivers' skills to support the health and well-being... (Review)
Review
Healthy parent-child relationships are clearly critical to healthy child development. Parenting programs develop caregivers' skills to support the health and well-being of children. Rigorous evidence has demonstrated the efficacy of these programs. Rising rates of child and youth depression, anxiety, grief, and suicide, both prior to and compounded by the COVID-19 pandemic, provide further reasons to implement parenting programs that support all parents in their essential roles. Parents can act as a buffer to stressors and support for children's well-being when they have the knowledge and skills to do so. Pediatric primary care practices are a natural setting for parenting programs, but challenges, including stigma, technology, workflow issues, and funding, have prevented their broad dissemination, implementation, and sustainability. In this article, we develop a framework for implementing parenting programs in primary care and present key considerations for selecting programs that fit the needs of parents, providers, patients, and the practice. We offer lessons from our experiences in overcoming these challenges, using the updated Consolidated Framework for Implementation Research to structure our discussion. We also provide an initial stepwise process which readers may use to plan their own parenting program implementation. Pediatric clinicians and practices can use this article and associated resources to plan, implement, and evaluate parenting programs in their practices as a strategy to help address the growing youth mental health crisis. Improving parenting behaviors can reduce the need for current or future mental health interventions by supporting optimal child development, emotional regulation, and parent-child relationships.
Topics: Adolescent; Child; Humans; Parenting; Pandemics; Parents; Parent-Child Relations; Primary Health Care
PubMed: 37088132
DOI: 10.1016/j.acap.2023.04.006 -
Journal of Consulting and Clinical... Aug 2023To examine the relationship between health belief model (HBM; i.e., perceived threat, benefits, costs, and self-efficacy) and theory of planned behavior (TPB; i.e.,...
OBJECTIVE
To examine the relationship between health belief model (HBM; i.e., perceived threat, benefits, costs, and self-efficacy) and theory of planned behavior (TPB; i.e., attitudes, social norms, and perceived behavioral control) constructs and parents' intention to participate and initial engagement (i.e., recruitment, enrollment, and first attendance) with a parenting intervention.
METHOD
Participants were parents ( = 699, mean age = 38.29 years, 90.4% mothers) of 2-12-year-old children. The study conducted secondary analysis of cross-sectional data collected for an experimental study of engagement strategies. Participants provided self-report data on HBM constructs, TPB constructs, and intention to participate. Measures of initial parent engagement were also collected (i.e., recruitment, enrollment, and first attendance). Logistic regressions evaluated the impact of HBM and TPB constructs, and their combination, on intention to participate and initial parent engagement.
RESULTS
Analyses indicated that all HBM constructs increased the odds of parents' intention to participate and enrollment. In terms of TPB, parents' attitudes and subjective norms, but not perceived behavioral control, were significant predictors of intention to participate and enrollment. When combined in one model, parents' perceived costs, self-efficacy, attitudes, and subjective norms predicted intention to participate, whereas perceived threat, costs, attitudes, and subjective norms increased odds of enrolling in the intervention. Regression models for first attendance were not significant and those for recruitment could not be conducted due to lack of variance.
CONCLUSIONS
The findings demonstrate the relevance of using both HBM and TPB constructs when enhancing parent intention to participate and enrollment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Child; Female; Humans; Adult; Child, Preschool; Parenting; Cross-Sectional Studies; Parents; Intention; Health Behavior
PubMed: 37141031
DOI: 10.1037/ccp0000816 -
Assessment of Feasibility and Acceptability of the Pathways for Parents After Incarceration Program.Family & Community HealthMost incarcerated fathers have connections to their families, and the quality of their family relationships is important not only to their reentry success but also to...
Most incarcerated fathers have connections to their families, and the quality of their family relationships is important not only to their reentry success but also to shaping positive child and family outcomes. However, there is a lack of rigorous evidence about interventions designed to strengthen parent-child and other family relationships among formerly incarcerated parents. The purpose of this study was to develop and assess for feasibility and acceptability an intervention for formerly incarcerated fathers, co-parents, and their children. We created and implemented the Pathways for Parents after Incarceration Program (P4P), a multilevel intervention that focuses on strengthening positive parenting skills, building constructive co-parenting strategies, providing social support, and connecting families to needed specialized services. We delivered P4P virtually to 3 groups of participants, collecting data at several points. Results suggest that while the program was well liked and appreciated by participants and parent coaches and had a positive effect on parenting skills and attitudes, recruitment and retention were challenging. Findings suggest that P4P has the potential to support child and family well-being when fathers reenter by bolstering protective factors, and supporting access to necessary supports associated with improved reentry outcomes. Additional research is needed to address feasibility concerns and establish program efficacy.
Topics: Humans; Child; Feasibility Studies; Parents; Parenting; Child Rearing
PubMed: 37696016
DOI: 10.1097/FCH.0000000000000375 -
Der Nervenarzt Sep 2023The parent-child relationship is the earliest and one of the most important close social relationships in a person's life. It begins even during pregnancy, is expressed... (Review)
Review
The parent-child relationship is the earliest and one of the most important close social relationships in a person's life. It begins even during pregnancy, is expressed in interactions and is accompanied by many neurobiological processes. A sensitive interaction with the parent who is well-adapted to the needs of the child, is necessary for a healthy child development; however, parents with mental disorders often face more difficulties in parenting than healthy parents. They tend to exhibit more intrusive or withdrawn behavior and report experiencing increased stress in parenting, which in turn can be a risk factor for the mental disorder. At the same time, parenting can be a great resource. Early recognition of stress in parenting is central to healthy child development and also to the parent's mental health. In addition to disorder-specific treatment for parents, parent-child focused interventions can be used in relationship or interaction disorders. This article presents and discusses different prevention and intervention approaches.
Topics: Female; Pregnancy; Humans; Parents; Parenting; Parent-Child Relations; Mental Disorders; Child Development
PubMed: 37171658
DOI: 10.1007/s00115-023-01491-7 -
The Journal of Adolescent Health :... Oct 2023Advancements in technology have made it possible to deliver parenting interventions online, known as eHealth interventions. Little is known about the rate at which...
PURPOSE
Advancements in technology have made it possible to deliver parenting interventions online, known as eHealth interventions. Little is known about the rate at which parents participate in eHealth interventions, characteristics of parents who watch eHealth interventions at an accelerated pace (i.e., binge-watching), and if binge-watching impacts intervention outcomes.
METHODS
The sample included 142 Hispanic parents who were randomly assigned to an eHealth family-based intervention and completed 100% of eight online, prerecorded and self-paced video group sessions delivered across 12 weeks. We examined baseline predictors (parent sociodemographic characteristics, report of child's externalizing behaviors, and family functioning) of watching group sessions in two weeks or less (n = 23, 16.2%). Using latent growth curve modeling, we tested the impact of binge-watching on the trajectory of adolescent drug use, condomless sex, and depressive symptoms across 36 months. We also examined the impact of binge-watching on changes in family functioning from baseline to 6 months postbaseline.
RESULTS
Parents with high levels of education and of children with attention problems were more likely to binge-watch. Conversely, parents of children with conduct disorder symptoms were less likely to binge-watch. The trajectory of depressive symptoms increased for adolescents with parents who binge-watched the intervention, but the trajectory of condomless sex decreased. There was no impact on drug use. Binge-watching was also associated with decreases in parental monitoring.
DISCUSSION
The findings of this study have implications for eHealth interventions; the pace that parents watch eHealth interventions may subsequently impact adolescent outcomes, such as condomless sex and depressive symptoms.
Topics: Child; Adolescent; Humans; Parents; Parenting; Depression; Unsafe Sex; Substance-Related Disorders; Telemedicine
PubMed: 37422740
DOI: 10.1016/j.jadohealth.2023.05.021 -
Journal of Health and Social Behavior Sep 2023Life course theories suggest that fathers' lifetime criminal legal system contact could contribute to poor parent-child outcomes via deterioration in couple relationship...
Life course theories suggest that fathers' lifetime criminal legal system contact could contribute to poor parent-child outcomes via deterioration in couple relationship quality and fathers' behavioral health. Using paired, longitudinal data from the Multi-site Family Study (N = 1,112 couples), the current study examines the influence of three dimensions of fathers' life course legal system contact on individual and parent-child outcomes. In fitted models, accumulated system contact in adulthood predicts fathers' later depressive symptoms and drug misuse, which in turn predict diminished father-child relationship quality (as reported by both co-parents). Fathers who were older at the time of their first arrest had poorer relationships with their children's mothers and, in turn, poorer behavioral health and parent-child outcomes. Conditions of confinement during fathers' most recent prison stay do not significantly predict later parent-child outcomes, net of the influence of age at first arrest and accumulated criminal legal system contact in adulthood.
Topics: Male; Female; Humans; Fathers; Life Change Events; Criminals; Parents; Mothers; Father-Child Relations; Parenting
PubMed: 36541142
DOI: 10.1177/00221465221139246 -
Journal of Community Psychology Sep 2023This community-engaged study aimed to understand effective strategies for disseminating online parenting resources (OPRs) in schools. OPRs were disseminated through...
This community-engaged study aimed to understand effective strategies for disseminating online parenting resources (OPRs) in schools. OPRs were disseminated through seven E-Parenting tips and eight Facebook posts. Facebook posts were viewed a total of 12,404 times, and each post reached an average of 505 people each month. Average engagement rate was 2.41% per post. E-Parenting tips yielded 1514 total clicks, and the average clicks per message was 216.29. E-Parenting tips related to internalizing problems (e.g., anxiety, depression) had a higher click rate than E-Parenting tips related to externalizing problems (e.g., oppositional behavior). OPRs disseminated through Facebook posts, and E-Parenting tips resulted in wide reach and engagement. Different media channels should be utilized to disseminate different OPRs to as many parents as possible.
Topics: Humans; Parenting; Social Media; Parents; Schools
PubMed: 37329566
DOI: 10.1002/jcop.23068 -
Journal of Medical Internet Research Jan 2024Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting... (Review)
Review
BACKGROUND
Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent's capacity to modify. However, engagement with such programs is suboptimal.
OBJECTIVE
This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement.
METHODS
Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent's capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values.
RESULTS
We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program's design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes.
CONCLUSIONS
This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context.
TRIAL REGISTRATION
PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819.
Topics: Adolescent; Humans; Adverse Childhood Experiences; Parents; Parenting; Behavior Therapy; Technology
PubMed: 38241066
DOI: 10.2196/43994