Child Adult Relationship Research Articles

Evaluation of Virtual Enhanced Child Adult Relationship Enhancement in Primary Care Intervention.

Because of COVID-19 pandemic social distancing requirements, the in-person Child Adult Relationship Enhancement in Primary Care (PriCARE) positive parenting intervention was adapted for virtual delivery. Objective was to evaluate the efficacy of the virtual PriCARE program to improve parenting capacity, decrease child behavioral problems, and decrease child maltreatment risk. Caregivers of children 2 to 6 years old recruited from pediatric primary care were randomized to PriCARE (n = 92) or waitlist control (n = 90). Dysfunctional parenting, positive parenting skills, child behaviors, and child maltreatment risk were measured at baseline and 2 to 3 months after intervention using the Parenting Scale (PS), Dyadic Parent-Child Interaction Coding System (DPICS), Eyberg Child Behavior Inventory (ECBI), and Child Abuse Potential Inventory (CAPI). Kruskal-Wallis test compared median change scores from baseline to follow-up by treatment arm. Of 182 enrolled caregivers, 92% (168) were mothers and 67% (122) completed study measures at baseline and follow-up. The median decrease (improvement) in total PS score was greater in the PriCARE group compared with the control group (-0.3 [IQR 0.69] vs -0.1 [IQR 0.56], p = 0.028) as was the median decrease (improvement) in ECBI problem score (-3 [IQR 9] vs -1 [IQR 7], p = 0.045) and ECBI intensity score (-9 [IQR 21] vs 0 [IQR 25], p = 0.006). Improvements in 4 positive parenting skills measured by DPICS were greater in the PriCARE group compared with the control group (all p< 0.003). Median decrease in CAPI abuse score did not differ significantly by study arm ( p = 0.055). The PriCARE virtual adaptation demonstrated promise in promoting positive parenting and decreasing child behavior problems.

Interacting adult-child relationships and school adjustment: Findings from growing up in Ireland

Although children's relationships with their parents and teachers contribute to their school adjustment and achievement, few studies have examined interactions between these relationships, particularly for father-child relationships. Using the Growing Up in Ireland birth cohort (N = 7507, 50.3% male), we examined child-adult relationship quality – rated by parents at age 3 and by teachers at age 5 – as predictors of teacher-rated behavioural adjustment and academic achievement at age 9 (indexed by self-reported academic self-concepts and performance on formal reading assessments). Controlling for prior levels of problem behaviours, verbal ability, and family SES, our results indicated that children's relationships with parents and teachers showed small and comparable independent effects on school adjustment and achievement. For mothers and teachers, moderation analyses showed a cumulative risk pattern for conflictual relationships and a compensatory pattern for close relationships. Children are likely to benefit from improving closeness and reducing conflict in adult-child relationships as well as interventions that involve mothers, fathers, and teachers.

Child Adult Relationship Enhancement in Primary Care (PriCARE) theory of change: A promising intervention to reduce child maltreatment

Child maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective, scalable prevention programs. Because problematic parent-child relationships lie at the core of CM, interventions targeting this relationship hold promise as CM prevention strategies. Evidence-based positive parenting interventions, as discussed here, are manualized behavioral interventions that focus on teaching caregivers positive parenting skills and techniques to improve the effectiveness of their parenting and improve their relationship with their child. In this article, we describe one specific parenting intervention, Child Adult Relationship Enhancement in Primary Care (PriCARE)/Criando Niños con CARIÑO, and review the proposed mechanisms through which PriCARE may contribute to CM prevention. PriCARE is a 6-session group parenting intervention for parents of 2-to-6-year-old children. PriCARE was developed and iteratively adapted with input from racially and ethnically diverse families, including low-income families, and was designed specifically for implementation in primary care with inclusion of strategies to align with usual care workflow to increase uptake and retention. PriCARE has the potential to reduce risk of CM directly through improving parenting behaviors and indirectly through the impact of those changes in parenting behaviors on child behaviors. PriCARE has also been shown to reduce parenting-related stress. Finally, by strengthening and bringing warmth to the parent-child relationship, PriCARE may buffer against the negative health consequences associated with CM and childhood adversity.

A Feasibility Study on the Virtual Adaptation of Child–Adult Relationship Enhancement in Primary Care

A Feasibility Study on the Virtual Adaptation of Child–Adult Relationship Enhancement in Primary Care

KONCEPT NAIVNE PESME – LICA MODERNOSTI DUŠANA RADOVIĆA I MILOVANA DANOJLIĆA

The aim of the paper is to trace the historical development of the perception of children and childhood, as a relevant age important for human development, in contemporary poetry for children, primarily illuminating the child-adult relationship. An overview of the different stages in the understanding of this relationship and the nature of children’s literature is given, and a special emphasis is placed on the forms of modernity in the poetic texts of Dušan Radović and Milovan Danojlić and their concept of a naive poem.

Wzywam o magna charta libertatis – aktualność Korczakowskiego wezwania

The article presents the topicality of Janusz Korczak’s pedagogy and his call for respecting children’s rights. Attention was paid to human dignity as the foundation of children’s rights, children’s citizenship and children’s subjectivity. The aim of the research undertaken is to diagnose the unique institution and pedagogical label that is the Order of the Smile, to show its social legitimacy over fifty years, as well as to show the exemplification of Korczak’s idea of a reversed child-adult relationship, where it is no longer just the child who draws on the wisdom of the adult, but it is the adult who learns from the child. Additionally, the analysis aims to give credence to a new model of education based on child citizenship, children’s rights and the expression of the child’s voice in the public space, where it is the children who promote the adults by introducing them to the arena of the Knights of the Order of the Smile. The research on the Order of the Smile presented in this paper draws on both traditional monographs of the institution and contemporary case studies. The institution of the Order of the Smile was indicated as a socio-cultural phenomenon of the world of children and adults, and at the same time a guarantor of the implementation of Korczak’s call for children’s rights, for magna charta libertatis, which reflects Korczak’s model of child-adult relations.

Child Adult Relationship Enhancement in Primary Care (PriCARE): study design/protocol for a randomized trial of a primary care-based group parenting intervention to prevent child maltreatment

BackgroundChild maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective, scalable prevention programs. Problematic parent-child relationships lie at the heart of CM. Parents who maltreat their children are more likely to have punitive parenting styles characterized by high rates of negative interaction and ineffective discipline strategies with over-reliance on punishment. Thus, parenting interventions that strengthen parent-child relationships, teach positive discipline techniques, decrease harsh parenting, and decrease child behavioral problems hold promise as CM prevention strategies. Challenges in engaging parents, particularly low-income and minority parents, and a lack of knowledge regarding effective implementation strategies, however, have greatly limited the reach and impact of parenting interventions. Child Adult Relationship Enhancement in Primary Care (PriCARE)/Criando Niños con CARIÑO is a 6-session group parenting intervention that holds promise in addressing these challenges because PriCARE/CARIÑO was (1) developed and iteratively adapted with input from racially and ethnically diverse families, including low-income families and (2) designed specifically for implementation in primary care with inclusion of strategies to align with usual care workflow to increase uptake and retention.MethodsThis study is a multicenter randomized controlled trial with two parallel arms. Children, 2–6 years old with Medicaid/CHIP/no insurance, and their English- and Spanish-speaking caregivers recruited from pediatric primary care clinics in Philadelphia and North Carolina will be enrolled. Caregivers assigned to the intervention regimen will attend PriCARE/CARIÑO and receive usual care. Caregivers assigned to the control regimen will receive usual care only. The primary outcome is occurrence of an investigation for CM by child protective services during the 48 months following completion of the intervention. In addition, scores for CM risk, child behavior problems, harsh and neglectful parenting behaviors, caregiver stress, and caregiver-child interactions will be assessed as secondary outcome measures and for investigation of possible mechanisms of intervention-induced change. We will also identify PriCARE/CARIÑO implementation factors that may be barriers and facilitators to intervention referrals, enrollment, and attendance.DiscussionBy evaluating proximal outcomes in addition to the distal outcome of CM, this study, the largest CM prevention trial with individual randomization, will help elucidate mechanisms of change and advance the science of CM prevention. This study will also gather critical information on factors influencing successful implementation and how to optimize intervention referrals, enrollment, and attendance to inform future dissemination and practical applications.Trial registrationThis trial was registered on ClinicalTrials.gov (NCT05233150) on February 1, 2022, prior to enrolling subjects.

The game in the human being as a tool for its holistic construction for an integral conception of its cosmogony

With respect to the upbringing of children, customs have advanced significantly. In ancient times it was conceived that children should be ignored and that they did not begin to be taken into account until very late in childhood; gradually society has evolved and with it the approaches to a humanized relationship between adults and children. It is becoming more and more constant and at the same time relevant the actions that lead to enjoy the child-adult relationship. Propitiating a pertinent emotional and social development, not only in the family environment but also in the educational spaces; spaces where specific cultural and social pillars are cemented that effectively contribute to a better progress in the individual. The games strengthen the roles and position the individual in the most characteristic aspects of his personality.

67.2 iCARE: Internet-Based Child Adult Relationship Enhancement for Families at Risk for Emotional Dysregulation and Child Maltreatment

The COVID-19 pandemic has led to disruptions in school, daycare, and community supports, negatively impacting underlying mental health issues for both parents and children and further increasing the potential for child maltreatment. Internet-based Child-Adult Relationship Enhancement (iCARE) is a tier 2 intervention that aims to enhance parents’ relationship with children with emotional and behavioral problems and those at increased risk of maltreatment. Parents are taught to connect with children of different ages, support social-emotional learning, give effective directions, and address mild problematic behaviors.

Criando Niños Con Cariño : Primary Care-Based Group Parenting Program Adaptation and Pilot.

This study culturally adapted and piloted a primary care-based group parenting program (Child-Adult Relationship Enhancement in Primary Care, PriCARE) for Spanish-speaking, Hispanic parents of 2- to 6-year-old children. The process was informed by the cultural adaptation literature, expert consultation, and focus group data from 18 previous PriCARE, eligible Cariño , and initial Cariño test participants. As adaptations were made, an implementation framework was applied to systematically record all changes. Finally, parents of children aged 2 to 6 years participated in the Cariño pilot study (n = 32). Enrollment and attendance data were used to examine feasibility, and the Therapy Attitude Inventory (TAI) was administered postintervention to measure acceptability. Most adaptations were minor changes to make the adapted program, Criando Niños con Cariño , more appropriate, applicable, or acceptable. Some changes required reframing Cariño concepts (e.g., child-led play) or incorporating new concepts (e.g., respeto , armonía , and educación ) to better align Cariño goals with parents' values. Among the 121 dyads invited to participate in the Cariño pilot study, 52 (43%) enrolled. Among the 52 enrolled, 32 (62%) attended at least 4 of the 6 sessions and reported high satisfaction on the TAI (mean 47/50, range 33-50). Cariño is the result of a rigorous adaption process and incorporates multiple changes to ensure the translation reflects the intended meaning and to reframe the program goals and concepts in a culturally congruent manner. Pilot data suggest Cariño is feasible and acceptable to parents.

Developing and applying synergistic multilevel implementation strategies to promote reach of an evidence-based parenting intervention in primary care.

There is strong evidence that parenting interventions are effective at improving child behavioral health outcomes when delivered in coordination with pediatric primary care. However, there is a lack of focus on the implementation, including the screening and referral process, of parenting interventions in the primary care setting. This is contributing to the delay in the scale-up of parenting interventions and to achieving public health impact. To address this gap, we identified barriers and facilitators to physician screening and referrals to a primary care-based parenting intervention, and selected and piloted five synergistic strategies to improve this critical process. This effort successfully increased physician referrals of eligible patients to the intervention from 13% to 55%. This demonstration project may help advance the implementation of evidence-based interventions by providing an example of how to develop and execute multilevel strategies to improve intervention referrals in a local context.

The concept of “adult-child communication” in the perspective of future female educators and teachers

Abstract The article tackles the issue of defining the concept of “adult-child communication” from the point of view of female students of pedagogy, future teachers and educators. The introduction explains the issue of symbolic representation of real and imagined objects, events, and situations by means of concepts and their definitions. The next part of the article describes the results of a study carried out in the group of 255 female students, who were asked to define the concept of “adult-child communication”. The study yielded a description of the concepts used to describe the defined concept and the signs of evaluation contained in the definitions. The final part of the article identifies and outlines four categories of the “adult-child communication” concept and discusses three types of definitions created by the respondents. The following types were distinguished: definitions similar to professional ones in terms of content and form, common definitions regarding the child-adult relationship with elements of professional vocabulary, common definitions and puerile definitions.

51.2 ICARE: INTERNET-BASED CHILD-ADULT RELATIONSHIP ENHANCEMENT FOR FAMILIES AT RISK FOR EMOTIONAL DYSREGULATION AND CHILD MALTREATMENT

Objectives: Slowing the spread of the SARS-CoV-2 virus has necessitated families to remain socially isolated at home. The pandemic has led to increased emotional, financial, and educational turmoil. Its impact has exacerbated underlying mental health issues for both parents and children and has increased risk for child maltreatment. The pandemic has also posed unique challenges to delivering mental health interventions to families. Internet-Based Child-Adult Relationship Enhancement (iCARE) is a tier 1 and 2 intervention that aims to enhance parents’ relationship with children with emotional and behavioral problems and those at increased risk of maltreatment. Parents are taught to connect with children of different ages, support social-emotional learning, give effective directions, and address mild problematic behaviors. Methods: The presentation will focus on describing a novel 6-week parenting skills workshop called iCARE for parents of children aged 2 to 6 years. It will also provide preliminary qualitative and quantitative results on the feasibility and possible effectiveness of this intervention. Changes in parents’ satisfaction and parenting attitudes, parental stress level, and child behavior problems will be shared. Results: Participants will learn about an intervention for parents who are already seeking mental health services in an academic outpatient center. They will understand the feasibility of using an internet-based group format as a mental health intervention. Participants will consider its potential effectiveness. Lastly, they will understand how this type of group may be implemented in their own practice. Conclusions: The COVID-19 pandemic has created an acute mental health crisis. Many families are requiring mental health care. Providing accessible, effective interventions for families will continue to be of great importance. P, PSC, TREAT

ICARE, SPACE, I-PCIT, AND ONLINE MINDFUL PARENTING: IMPROVING ACCESS BY INTERNET-DELIVERED THERAPIES FOR YOUNG CHILDREN AND FAMILIES

Objectives: Telepsychiatry has become increasingly common over the past 2 decades, with numerous benefits that include increasing accessibility by overcoming geographical and transportation barriers, increasing efficiency, reducing cost, and diminishing stigma linked to mental health clinics. This past year, the wider dissemination of telehealth services has been expedited due to the current COVID-19 public health crisis and stay-at-home orders that have resulted in decreased restrictions and historic expansion of telehealth insurance coverage. This Clinical Perspectives will discuss internet-delivered parent-based young child interventions (ages 0-5 years), such as internet-based Child-Adult Relationship Enhancement (iCARE), Supportive Parenting for Anxious Childhood Emotions (SPACE), Internet-Delivered Parent-Child Interaction Therapy (I-PCIT), and Mindful Parenting, and their empirical evidence, underlying theories, and clinical and supportive applications. Methods: This presentation will consist of a discussion of 4 interventions adapted to be delivered virtually: 1) I-PCIT will use case examples to illustrate various challenges and necessary adaptations for internet therapies for young children;2) iCARE;3) a parent-based treatment program called SPACE that was developed for children with anxiety and OCD;and 4) internet-delivered mindful parenting with challenges and adaptations for digital delivery with case examples. At the conclusion of our presentation, we will invite the participants to bring their own practical challenges regarding online treatments of young children and their families. Results: Participants will learn about different innovative internet-delivered therapies for young children and their families. They will develop strategies on “website manners,” treatment tools and strategies on engaging children and their families via the internet. They will learn about treatment options for a variety of internalizing and externalizing disorders in young children that can be delivered effectively online. Conclusions: Video engagement of young children and their families presents unique challenges. Evidence-based interventions have been successfully adapted for online delivery. This session will allow participants to discuss and explore ideas and gain tools for optimizing internet-delivered therapies for young children. P, EC, TVM

‘Models of possible selves: teachers’ reflections on childhood memories of parents’

ABSTRACT This study draws from theories of attachment to examine prospective teachers’ reflections on the role of the parent in their childhood memories in shaping the imagination of their future selves. As part of a larger qualitative study, we collected and analyzed the memory narratives of teacher candidates and undergraduate students preparing to work with children, and selected 53 of the 116 narratives that featured parents. These memories demonstrate three ways in which parents figured into the participants’memories and reflections on their motivations to work with children: 1) as supportive role models, 2) as catalysts of sympathy for children whom teachers imagine as lacking the privileges their own parents provided, and 3) as spurs for empathy towards children whom they identify with as experiencing challenging situations. In each case, the participant created an internal working model of the child-adult relationship in their memory and imagined themselves taking up a parallel role as the adult in a future child-adult relationship. As teacher educators concerned with the identity work of preservice teachers, our findings highlight the importance of critically exploring childhood memories of parents as models for the teacher-child relationship.

Associations Among Parental Caregiving Quality, Cannabinoid Receptor 1 Expression-Based Polygenic Scores, and Infant-Parent Attachment: Evidence for Differential Genetic Susceptibility?

Attachment is a biological evolutionary system contributing to infant survival. When primary caregivers/parents are sensitive and responsive to their infants’ needs, infants develop a sense of security. Secure infant attachment has been linked to healthy brain and organ-system development. Belsky and colleagues proposed the term differential susceptibility to describe context-dependent associations between genetic variations and behavioral outcomes as a function of parenting environments. Variations in the Cannabinoid Receptor Gene 1 (CNR1) are associated with memory, mood, and reward and connote differential susceptibility to more and less optimal parental caregiving quality in predicting children’s behavioral problems.AimTo determine if parental caregiving quality interacts with children’s expression-based polygenic risk score (ePRS) for the CNR1 gene networks in the prefrontal cortex, striatum, and hippocampus in predicting the probability of attachment security and disorganized attachment.DesignProspective correlational methods examined maternal-infant pairs (n = 142) from which infants provided DNA samples at 3 months. Parental caregiving quality was assessed via the Child Adult Relationship Experiment (CARE)-index at 6 months, and attachment security via the Strange Situation Procedure at a mean age of 22 months. The CNR1 ePRSs include genes co-expressed with the CNR1 genes in the prefrontal cortex, striatum, or hippocampus, and were calculated using the effect size of the association between the individual single nucleotide polymorphisms from those genes and region-specific gene expression (GTEx). Logistic regression was employed (alpha < 0.05, two-tailed) to examine the main and interaction effects between parental caregiving quality and ePRSs in predicting attachment patterns. Interpretation of results was aided by analyses that distinguished between differential susceptibility and diathesis-stress.ResultsSignificant interactions were observed between (1) maternal sensitivity and ePRS in the striatum in predicting attachment security, (2) maternal unresponsiveness with the ePRS in the hippocampus in predicting disorganization, and (3) maternal controlling with the ePRS in the hippocampus in predicting disorganization.ConclusionThese findings offer support for genetic differential susceptibility to the quality of maternal sensitivity in the context of the ePRS in the striatum. However, the significant interactions between hippocampal ePRS and maternal unresponsiveness and controlling in predicting the probability of disorganization were more suggestive of the diathesis-stress model.

The preterm infant-parent programme for attachment-PIPPA Study: a randomised controlled trial.

There is increasing recognition of adverse mental health consequences of preterm birth and the impact on social-emotional development. However, the quality of the developing parent-infant relationship may be protective, with enhanced maternal sensitivity to infants' cues associated with improved outcomes. Eighty mothers and their preterm infants born <32 weeks gestation were randomised to intervention and standard care groups. Intervention comprised reflective interview, observation of infant cues and video interaction guidance (VIG). The primary outcome, maternal sensitivity during play, was measured by the Child Adult Relationship Evaluation-Index. Secondary outcomes were infant social-emotional problems measured by the Ages and Stages Questionnaire-Social-Emotional version. There was no statistically significant difference between the intervention and standard care groups in maternal sensitivity during play at 9 months corrected age (CA). In the secondary outcome analysis at 12 months CA, infants in the intervention group had fewer self-regulation problems than infants whose mothers received standard care. Per-protocol analysis revealed that infants whose mothers completed VIG had significantly fewer communication problems. This early attachment-focussed intervention integrating VIG for mothers and their preterm infants did not enhance maternal sensitivity; however, there were effects on infant social-emotional problems at 12 months CA. Preterm birth can adversely affect infant and parent mental health and the quality of the parent-infant relationship. Early intervention to support parent-infant interaction can have positive effects on infant social-emotional development. There was no statistically significant difference in maternal sensitivity during play at 9 months CA. However, there were fewer infant self-regulation and communication problems reported by mothers at 12 months CA following intervention. Further evaluations of attachment-focussed interventions in the neonatal intensive care unit are needed.

Como fazer pesquisa com crianças em tempos de pandemia? Perguntemos a elas

Este artigo é sobre perguntas: sobre como e o que perguntar às crianças, em uma situação de pandemia, e sobre as respostas-perguntas que elas deram aos nossos questionamentos. Descrevo inicialmente o processo de elaboração compartilhada, entre adultos e crianças, de um questionário direcionado a crianças de 06 a 12 anos de idade que vivenciaram o isolamento social decorrente da pandemia de Covid-19. No processo de análise das respostas constatei que algumas foram dadas em forma de pergunta. A pergunta aparece como desafio, como dúvida, como reflexão das crianças em relação às categorias, demandas e percepções que nós, adultos-pesquisadores frequentemente projetamos em nossas pesquisas. Problematizar a relação criança-adulto na realização de pesquisas na confluência entre o teatro e a antropologia e valorizar o papel da pergunta neste processo é o objetivo deste artigo.

Integrated CARE: Adaptation of Child-Adult Relationship Enhancement (CARE) Model for Use in Integrated Behavioral Pediatric Care

The authors adapted the established Child-Adult Relationship Enhancement (CARE) interaction model for use in integrated behavioral health clinics. CARE was modified for delivery in the examination room, during routine primary care visits. Adopting a real-world implementation approach, clinical social workers were trained in the new model-IntegratedCARE-and provided the brief, 3-session treatment to 30 different parent-child dyads. Measurements included the Parental Stress Index-4 Short Form (PSI 4-SF), the Eyberg Childhood Behavior Inventory (ECBI), and the Therapy Attitude Inventory (TAI). There was a statistically significant mean score decrease on the both subscales of the ECBI at pre- and posttreatment. Scores on the TAI indicated that participants were satisfied with the treatment. Attrition rates were somewhat lower than similar studies. Findings indicate the IntegratedCARE model is feasible for sustainable delivery by trained behavioral health professionals in primary care.

Improving Child Behaviors and Parental Stress: A Randomized Trial of Child Adult Relationship Enhancement in Primary Care.

Prior single-site evaluations of Child Adult Relationship Enhancement in Primary Care (PriCARE), a 6-session group parent training, demonstrated reductions in child behavioral problems and improvements in positive parenting attitudes. To measure the impact of PriCARE on disruptive child behaviors, parenting stress, and parenting attitudes in a multisite study. Caregivers of children 2- to 6-year-old with behavior concerns recruited from 4 pediatric primary care practices were randomized 2:1 to PriCARE intervention (n=119) or waitlist control (n=55). Seventy-nine percent of caregivers identified as Black and 59% had annual household incomes under $22,000. Child behavior, parenting stress, and parenting attitudes were measured at baseline and 2 to 3 months after intervention using the Eyberg Child Behavior Inventory, Parenting Stress Index, and Adult-Adolescent Parenting Inventory-2. Marginal standardization implemented in a linear regression compared mean change scores from baseline to follow-up by treatment arm while accounting for clustering by site. Mean change scores from baseline to follow-up demonstrated greater improvements (decreases) in Eyberg Child Behavior Inventory problem scores but not intensity scores in the PriCARE arm compared to control, (problem: -4.4 [-7.5, -1.2] vs -1.8 [-4.1, 0.4], P= .004; intensity: -17.6 [-28.3, -6.9] vs -10.4 [-18.1, -2.6], P= .255). Decreases in parenting stress were greater in the PriCARE arm compared to control (-3.3 [-4.3, -2.3] vs 0 [-2.5, 2.5], P= .025). Parenting attitudes showed no significant changes (all P> .10). PriCARE showed promise in improving parental perceptions of the severity of child behaviors and decreasing parenting stress but did not have an observed impact on parenting attitudes.