Parent Outcomes Research Articles

Patterns and relationships of prolonged grief, post-traumatic stress, and depressive symptoms in Chinese shidu parents: Latent profile and network analyses

Parents who experience the trauma of losing an only child are called “shidu” parents in China. There are individual differences in post-loss outcomes.1,061 Chinese shidu parents were asked to complete questionnaires assessing prolonged grief, post-traumatic stress, and depressive symptoms. The mean age of the sample was 59.68 (SD = 7.52), with the average time since the loss was 9.46 years (SD = 7.05). Most participants were female (62.3%). The main cause of the loss was an unnatural case (52.7%). Latent profile analysis was used to identify similar symptom patterns. Network analysis was used to explore the relationships among symptoms within different subgroups. A two-profile model based on symptom severity identified a “low symptom severity” subgroup (n = 419) and a “high symptom severity” subgroup (n = 642). In the low symptom severity subgroup network, the most central symptoms were loss of interest, feeling numb, and meaninglessness. In the high symptom severity subgroup network, the most central symptoms were physiological cue reactivity, emotional pain, and feeling easily startled. Individual differences in the post-loss outcomes of Chinese shidu parents are reflected not only in symptom patterns but also in the relationships among symptoms.

How Sexism in Institutions and Everyday Interactions Shapes Early Childbearing

Early childbearing is associated with poor outcomes for parents and children, potentially exacerbating inequality within and across generations. Building on the structural sexism and health perspective, we argue that systemic gender inequality is a conceptually important—and understudied—factor in early childbearing. Using survey data from the National Longitudinal Study of Adolescent to Adult Health ( N = 5,052 female respondents and 32,595 person-years) merged to state, county, and school characteristics, we investigate how exposure to structural sexism during adolescence shapes early childbearing. We measure structural sexism in institutional domains with state and county-level measures of economic, cultural, and reproductive health. We also generate a novel measure of structural sexism in interactional domains, capturing gendered expectations, power dynamics, and conservative religious beliefs among school peers. We find that institutional sexism is associated with a higher likelihood of early childbearing among young women racialized as Black, but not among those racialized as White. Interactional sexism is also a significant predictor of early childbearing, and is especially salient for adolescents as they turn to peers for social cues about gender roles. Our results underscore the importance of institutional and interactional forces for shaping families and raise questions about increasingly polarized gender climates post- Dobbs.

Roles of Psychological Flexibility, Parenting Competence, and Asthma Management Self-Efficacy in the Functioning Outcomes of Parents of Children with Asthma Co-Occurring with Attention-Deficit/Hyperactivity Disorder

Asthma and ADHD represent prevalent pediatric conditions, with the former being a physical disorder and the latter being a neurodevelopmental disorder. This study examined the influence of parental psychological flexibility (PF)—the ability to adapt to evolving situational demands, shift perspectives, and balance competing priorities—alongside parenting competence and asthma management self-efficacy on family functioning and parental psychological adjustment in families with children exhibiting concurrent asthma and ADHD symptoms. Baseline data were analyzed from 130 parents (mean age = 40.3 years, SD = 5.5; 88.9% mothers) of children diagnosed with both asthma and ADHD (mean age = 8.0 years, SD = 2.2; 74.6% boys), who were participating in a randomized controlled trial evaluating an Acceptance and Commitment Therapy (ACT)-based parenting intervention. An adjusted structural equation model revealed that greater parental psychological inflexibility was significantly associated with poorer family functioning (β = −0.61, 95% CI [−0.74, −0.33], p < 0.001) and increased psychological maladjustment (β = 0.48, 95% CI [0.32, 0.63], p < 0.001), accounting for intercorrelations with parenting competence and parental asthma management self-efficacy. Additionally, parental psychological flexibility was found to mediate the relationship between parenting competence and both family functioning and psychological adjustment. These findings underscore the importance of targeting parental psychological inflexibility and enhancing parenting competence in interventions to improve family dynamics and parental mental health and thereby suggest a shift from the traditional focus on self-efficacy in symptom management for pediatric asthma and ADHD.

Unlocking Health Literacy: investigating Parental Health Literacy and Child Weight Outcomes

Abstract Background While parental health literacy (HL) is widely recognized as crucial for child health, research on its impact on children’s weight-related outcomes remains limited. This study aims to fill this gap by investigating the associations between parental HL and children’s anthropometric measurements, with a focus on child BMI Z-score and waist-to-height ratio (WHtR). Methods As part of a cluster randomized trial in primary schools serving vulnerable populations, 735 children (51.7% boys, mean age 7.7 years) participated. Parental HL was assessed using the HLS-Q12 questionnaire, comprising 12 items. Health literacy levels, standardized from 0 to 100, were categorized into ‘inadequate,’ ‘problematic,’ ‘sufficient,’ and ‘excellent’ HL. General HL and three specific domains-health promotion, disease prevention, and healthcare-were computed. Children’s weight, height, and BMI were measured following standardized procedures. Regression analyses examined HL’s impact on BMI Z-scores and WHtR. Results Parents with higher HL in disease prevention and health promotion had children with significantly lower BMI Z-scores, even after adjusting for parental education and children’s sex sex [-0.010 (-0.18; -0.0001) and -0.10 (-0.019; 0.01). Similar associations were found for WHtR [-0.0004 (-0.001; -0.0001)]. Parents with excellent HL in general and health promotion had significantly lower WHtR [-0.027 (-0.046; -0.008)] and BMI Z-score [-0.74 (-1.2; -0.28)]. Conclusions This study highlights the significant role of parental health literacy in shaping children’s weight-related outcomes. Higher levels of parental HL in disease prevention and health promotion were linked to lower BMI Z-scores and WHtR in children, independent of parental education and children’s sex. Enhancing parental HL, alongside promoting healthy behaviors and environments for children, could lead to more effective approaches for addressing this public health issue. Key messages • Parental health literacy is associated with children’s weight outcomes, emphasizing the need for HL-focused interventions. • Higher parental HL is associated with lower child BMI Z-scores and waist-to-height ratios, highlighting potential HL’s role in combating childhood obesity.

The Effectiveness of Trauma-Informed Parenting Programs for Traumatized Parents and Their Components: A Meta-Analytic Study.

Parents who have been exposed to trauma face distinct challenges in parenting that can lead to negative child developmental outcomes and intergenerational transmission of trauma. Parenting programs for traumatized parents seem promising, but the existing evidence on their effectiveness has not yet been synthesized. This study aimed to examine the overall effect of trauma-informed parenting programs on (a) parenting and (b) parental mental health outcomes by conducting two three-level meta-analyses. Moderator analyses were performed to identify whether program components, delivery techniques, and other study and program characteristics were associated with effectiveness. A literature search conducted up to August 2024 yielded 15 studies reporting on 110 effect sizes. Significant overall effects were found of trauma-informed parenting programs on both parenting outcomes (d = 0.75, 95% CIs = [0.09, 1.15], p = .027) and parental mental health outcomes (d = 0.21, 95% CIs = [0.09, 0.32], p < .001). The first meta-analysis on parenting found no significant moderators, while the second meta-analysis on parental mental health indicated that programs emphasizing child disciplining skills yielded smaller effects (d = 0.04) compared to programs without this component (d = 0.31). Programs using modeling techniques yielded larger effects (d = 0.32) compared to programs without (d = 0.14). Larger program effects on parental mental health were also found for programs with longer durations and when individual sessions were used. Thus, evidence supports the effectiveness of trauma-informed parenting programs in improving parenting and reducing parental mental health problems.

Playful activities mitigate relations between parental mental health difficulties and child verbal outcomes.

This study examined the role of parental involvement in the home learning environment in the association between parental mental health and child cognitive performance. In a sample of 174 three- to five-year-old children (52% female, 97% White, 7% Hispanic, 2019-2022), playful activities moderated the relation between parental general depression and child verbal reasoning and acquired verbal knowledge. However, there was no evidence that parental involvement moderated the association between parental mental health and child spatial reasoning. These results improve our understanding of the pathways by which parental mental health, even in a non-clinical community sample, relate to child outcomes and raise the possibility of leveraging playful activities as one mechanism to alleviate the potential role of parental mental health difficulties.

Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: A qualitative analysis.

Perinatal mental health disorders place a particularly high public health burden on South Africa (SA) via negative health outcomes for the birthing parent and adverse health outcomes for infants (e.g., low birth weight, preterm deliveries, malnourishment) as well as emotional and behavioral problems in children. Depression, posttraumatic stress disorder (PTSD), and other mental health disorders may also compromise engagement in HIV prevention behaviors during the perinatal period, when HIV acquisition risk increases. This is particularly important in SA, where almost a quarter of women between ages 15 to 49 have HIV. There is little research exploring the anticipated impacts mental health symptoms have on one's ability to emotionally connect or caregive after delivery; this critical information will enable providers to support women and their mental health during the transition from pregnancy to postpartum. HIV-negative pregnant persons were recruited from an antenatal clinic in Cape Town as a part of a larger study investigating mental health barriers to pre-exposure prophylaxis (PrEP) uptake during pregnancy. Participants qualified for an in-depth interview based on elevated symptoms of depression and/or PTSD. The interviews explored the likely impact of their mental health symptoms on their baby's wellbeing, their ability to bond with their baby, and their ability to meet their baby's needs. Following the principles of thematic analysis, we identified three main themes that described these relationships: (1) a strong perceived connection between maternal mental health and baby's wellbeing; (2) perceived strains on bonding with the baby; and (3) negative impact of mental health on likelihood of completing parenting tasks. This study will inform future mental health programming to prepare pregnant persons with mental health symptoms for a successful postpartum period with respect to bonding and caring for their infant.

Evaluation of a Model of Transitional Care After Preterm Birth on Parents' Mental Health and Self-Efficacy: A Randomized Controlled Pilot Trial.

Parents of premature infants experience depression, anxiety, post-traumatic stress disorder, and increased stress, which can negatively impact parent-infant relationships and infant development. To reduce negative consequences and optimally support families, we developed the Transition to Home model (TtH). In this randomized controlled pilot trial (RCT), the feasibility of performing an experimental study to analyse the effects of TtH on parental mental health over time was evaluated. The following domains were assessed: recruitment, follow-up and study burden, outcome measures used and parental mental health outcomes. We included n = 22 parent couples with their preterm infants in the control group and n = 23 in the intervention group. Depression, anxiety and post-traumatic stress disorders, parenting stress, and parental self-efficacy were assessed at five timepoints. The study burden was evaluated once at the end of the study. The control and intervention groups had similar socio-demographic characteristics. The groups showed no differences in the mental health outcomes except for depression in mothers at T2 (p = 0.042) and T5 (p = 0.027) and state anxiety in fathers at T2 (p = 0.016). This pilot RCT established a framework for the evaluation of the TtH model of care and demonstrated the viability of the evaluation scheme. The results confirm the suitability of the RCT's structure and the feasibility of the methods and instruments used. Minor adjustments are recommended to include a more diverse sample in future studies.

The effects of neighborhood perceptions on response to a technology-assisted parenting intervention for adolescent substance use: protocol of a diversity supplement to parent SMART (Substance Misuse in Adolescents in Residential Treatment)

BackgroundIt is well established that an adolescent’s neighborhood is associated with their likelihood of developing a substance use disorder. The availability of drugs, lack of access to resources, and exposure to violence are all associated with greater substance use among young people, leading to more pronounced health inequities. Technology assisted interventions (TAIs) have been touted to enhance the reach of substance use treatment and improve outcomes for high-need families living in underserved neighborhoods. A key question is whether neighborhood characteristics impact the effectiveness of TAIs, given these interventions are embedded within an adolescent’s natural environment. This National Institute on Drug Abuse-funded Diversity Supplement will examine the role of perceived neighborhood characteristics on response to Parent SMART, a TAI for parents of adolescents in residential substance use treatment (R37DA052918; PI: Becker). Aim 1 will use both adolescent and parent self-report of multiple neighborhood dimensions (e.g., physical environment, social disorder, satisfaction with community resources) to identify indicators predictive of treatment response. Aim 2 will then explore the indirect relationship between neighborhood context and response to Parent SMART, via engagement.MethodsParticipants include adolescent and parent dyads enrolled in an effectiveness trial evaluating Parent SMART, a TAI for parents of adolescents in residential substance youth treatment. Participants will complete self-report measures of neighborhood physical environment, social disorder, and satisfaction with community resources at baseline to predict parenting and youth substance outcomes at 6-, 12-, and 24-weeks post discharge.DiscussionTo date, few studies have explicitly tested how neighborhood affects response to TAIs for adolescent substance use. Assessing adolescent and parent perceptions of neighborhood characteristics holds potential to pinpoint key contextual factors that affect TAI response and to promote consideration of multi-level health equity determinants in substance use research. Understanding neighborhood influences can advance public health by helping tailor TAIs to address the unique needs of adolescents living in underserved communities.Trial registrationThis study extends the measurement and analysis plan of a pragmatic effectiveness trial. The pragmatic effectiveness trial is registered at ClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385

Mental Health Outcomes of Parents with Children Enrolled in the Competence-Based Curriculum in Public Day Primary Schools in Nairobi County, Kenya

Involvement in their children's education through the Competency-Based Curriculum (CBC) significantly impacts the mental health outcomes of parents, necessitating a deeper understanding of how these educational demands influence parental well-being. This study examines the mental health outcomes of parents with children enrolled in the CBC in primary schools in Nairobi County, Kenya. Utilizing Cognitive Behavioral Theory (CBT), the research employed a quantitative approach with a cross-sectional survey design targeting parents with children enrolled in the CBC in primary schools. A multi-stage sampling technique resulted in a sample size of 376 parents. Data were collected using structured questionnaires, including the Parenting Sense of Competence (PSOC) scale, Multidimensional Fatigue Inventory (MFI), Parental Stress Scale, and New General Self-Efficacy Scale. Statistical analysis using SPSS Version 25 involved descriptive methods. The findings revealed generally positive mental health outcomes, with high levels of parenting satisfaction and self-efficacy, alongside moderate levels of mental fatigue and stress. These results align with CBT, emphasizing the role of positive beliefs and effective coping strategies in maintaining mental health. The study concludes that while CBC aims to enhance learning, it also creates challenges for parents that impact their mental health.

Exploring past research to move forward: a scoping review of aims, outcomes, and recommendations in parental mental illness qualitative research.

As parental mental illness is a global public health concern, rigorous qualitative research is central to understanding families' experiences, needs and outcomes to inform optimal service provision in adult mental health and children's social services. The current review identified, appraised and synthesized international qualitative research exploring Families and Parent Mental Illness (FaPMI) research to determine the focus, findings and outcomes and to summarize the recommendations made about the direction of future research. Findings are classified according to outcomes for children, parents, and families. While some children experienced positive outcomes from a parent's illness, most faced impacts on their social-emotional wellbeing, school performance, increased caregiving responsibilities, strained parent relationships, and lack of understanding about parental mental illness. Some family members endured abuse and struggled to adapt to an ill parent's unpredictable needs, with reluctance to discuss the situation. Parents found parenting challenging yet viewed having children as a protective factor. Future research should gather diverse perspectives, explore within-family factors and social environments, develop and test interventions, and address methodological issues like sampling. This review highlights the centrality of qualitative data in comprehensively understanding and evaluating outcomes of parental mental illness on families and provides clear recommendations regarding future research.

Longitudinal associations between parents' job characteristics, parenting, and adolescent academic outcomes

AbstractObjectiveThis study sought to understand the prospective relationship between parents' jobs, parenting, and adolescents' subsequent school performance.BackgroundRecent research shows that parents' poor job quality and work–family conflict (WFC) are adversely associated with young people's mental health and socioemotional well‐being, with much less known about impacts on adolescents' academic outcomes.MethodWe used data from a nationally representative Australian cohort study to test a longitudinal model linking parents' job characteristics, WFC, and parenting warmth and irritability in early high school, and adolescents' academic achievement in middle high school. Separate models were run for mothers (N = 2,676) and fathers (N = 2,615), and additional multigroup models examined differences between low‐income and middle‐ and high‐income parents.ResultsFindings suggest that parents' WFC increases parenting irritability, which in turn is adversely associated with academic outcomes, particularly for low‐income mothers. Findings also showed that low‐income fathers' WFC was directly associated with poorer academic outcomes.ConclusionParents' WFC in early high school may affect adolescents' achievement in middle high school, with some risks compounded for low‐income households.ImplicationsThis study is among the first to establish a relationship between parents' WFC and adolescents' academic performance and highlights the importance of parents' job resources in supporting adolescent academic outcomes.

A Digital Health Model for School-Based Implementation to Improve Parent and Child Outcomes: Comparison of Active Versus Light-Touch Coaching Effects.

Online or app-based parenting interventions have become more widely available in recent years. However, challenges related to poor engagement and high attrition have been noted in the literature, and there are important questions regarding ways to enhance parental engagement and improve treatment outcomes through digital health, including through the addition of therapeutic coaches. The current study evaluated differences in the effects of active versus "light-touch" coaching implementations of an enhanced version of Family Check-Up Online (FCU-O) on parent/family and child-level outcomes from pre-treatment to 2-month follow-up assessments. The enhanced version of the FCU-O was adapted to support families in coping with pandemic-related stressors to prevent youth behavioral and emotional problems during middle school and included app-based modules designed to support effective parenting practices as well as virtual coaching. In the "active-coach" condition, parenting coaches were active in efforts to arrange coaching sessions with parents as they worked through the app-based modules, while in the light-touch intervention, parent-coaches enrolled participants in the context of a one-time support session but did not actively pursue families to schedule additional sessions. Parents in the active-coach condition exhibited greater engagement with both the app and coaching sessions than parents in the light-touch condition. Further, stronger improvements in several aspects of parenting and child functioning were observed in the active-coach versus light-touch conditions. However, parents in the light-touch condition showed reductions in stress and comparable levels of dosage when using the app. Implications for prevention and accessibility of digital health interventions are discussed.

Black Clinicians' Perceptions of the Cultural Relevance of Parent-Child Interaction Therapy for Black Families.

Parent-child interaction therapy (PCIT) is a highly efficacious, evidence-based treatment for children with disruptive behaviors and their families. PCIT is a dyadic therapy designed to improve parent-child relationships and decrease children's behavioral problems. PCIT research specific to Black families is currently sparse. Given findings that Black families have a higher attrition rate and demonstrate fewer significant improvements in parental well-being outcomes, we sought to assess clinicians' perceived cultural alignment of PCIT with Black families. We conducted individual interviews via Zoom with 10 Black clinicians, trained in PCIT, who had experience treating Black families using PCIT. The research team generated the following themes using thematic analysis: cultural misalignment, manualization, barriers to treatment, generational patterns of discipline, racial considerations, and protocol changes. Findings indicate that Black clinicians have identified various points of cultural misalignment in providing PCIT with Black families, for which they have modified treatment or suggested changes to improve cultural sensitivity. Collating suggested clinician modifications to inform a cultural adaptation of PCIT for Black families may contribute to a reduction in the attrition rate and improvement in outcomes for Black families participating in PCIT.

Evaluating the effectiveness of Smoke-Free Home SafeCare, an integrated intervention, among families at risk for secondhand smoke exposure and child maltreatment in the United States: a study protocol for a hybrid type 1 trial

BackgroundSecondhand smoke exposure (SHS) and child maltreatment (CM) are preventable yet have negative lifelong impacts on health. When considered together, the risk for negative health outcomes may be compounded, especially for people living in low-resource settings. Evidence-based interventions exist for preventing CM and reducing SHS among families with low resources; however, no programs jointly target SHS exposure and maltreatment risk.MethodsThis study is a hybrid type 1 trial to examine the effectiveness of a systematically braided intervention to target CM risk and SHS in the home. Fifty SafeCare Providers will be randomized to deliver either standard SafeCare (i.e., the SafeCare model alone; active treatment control; n = 25) or Smoke-Free Home SafeCare (SFHSC; treatment condition; n = 25), the braided intervention that includes both SafeCare and the Smoke-Free Homes: Some Things are Better Outside intervention to N = 500 families. Aim 2 is to assess family-level outcomes. The primary outcome is a full home smoking ban, validated by air nicotine monitors; secondary outcomes include parenting and smoking outcomes. Aim 3 is to evaluate process and implementation outcomes, including cost–benefit. We will use multilevel models and ROC analyses to evaluate and validate the primary outcome. We will use tests of non-inferiority to evaluate secondary outcomes. Cost-effectiveness analyses will be used to assess cost–benefit of SFHSC.DiscussionThis study will be the first to document the outcomes of a multi-component intervention to address cumulative risk factors that impact cancer risk among children whose parents are at risk or involved in child-protective services. Integrating an evidence-based intervention that targets SHS exposure in the home with a broadly disseminated CM prevention intervention may be a sustainable way to help reduce the compounded effects of SHS in the home and CM.Trial registrationClinicaltrials.gov, NCT05000632. Registered on August 11, 2021.

The Effect of 5Q Parental Education on Children's Emotion through Healing of Inner Child among Parents

The research aim of this study is to understand the relationship between parental emotional well-being and child outcome. This study delves into the profound impact of 5Q parental education on children's emotional well-being through the intricate process of healing the inner child among parents. The 5Q framework, encompassing Intelligence Quotient (IQ), Emotional Quotient (EQ), Adversity Quotient (AQ), Social Quotient (SQ), and the innovative "You Quotient" (UQ), serves as the cornerstone of this transformative educational program. By intertwining principles of personal growth, self-awareness, and effective communication, the 5Q approach aims to empower parents to navigate the complex landscape of parenthood with confidence and competence. Central to this study is the concept of the inner child, deeply rooted in psychological theory, which symbolizes unresolved emotions and experiences from childhood that continue to influence adult behaviours and familial dynamics. Through a qualitative research methodology, this study rigorously examines the experiences of a diverse sample of 100 participants engaged in a comprehensive 6-month 5Q parental education program. Results from the qualitative analysis revealed a profound impact of the 5Q parental education program on participants' emotional well-being and parenting practices. An overwhelming majority of 82 out of 100 participants reported significant enhancements in their emotional intelligence (EQ) following the healing of their inner child. This transformation was characterized by heightened self-awareness, improved emotional regulation, improved parenting skills and strategies, strengthened parent-child relationship that foster suitability relationship. This study underscores the transformative potential of 5Q parental education in fostering nurturing family environments conducive to holistic child development. The understanding of the relationship between parental emotional well-being and child outcome is emphasized. By addressing the emotional needs of parents and facilitating the healing of their inner child, this program not only empowers individuals but also lays the foundation for resilient, empathetic, and emotionally intelligent generations to come, laying the foundation for their optimal development.

Cascade effects of a parenting-focused program for divorced families on three health-related outcomes in emerging adulthood.

Using data from a 15-year longitudinal follow-up of a randomized controlled trial of a parenting-focused preventive intervention for divorced families (N = 240) with children aged 9-12, the current study examined alternative cascading pathways through which the intervention led to improvements in offspring's perceived health problems, BMI, and cigarette smoking in emerging adulthood. It was hypothesized that the program would lead to improvements in these health-related outcomes during emerging adulthood through progressive associations between program-induced changes in parenting and offspring outcomes, including mental health problems, substance use, and competencies. Intervention-induced improvements in positive parenting at posttest led to improvements in mental health problems in late childhood/early adolescence, which led to lower levels of mental health and substance use problems as well as higher levels of competencies in adolescence, which led to improvements in the health-related outcomes. Academic performance predicted all three health-related outcomes and other aspects of adolescent functioning showed different relations across outcomes. Results highlight the potential for intervention effects of preventive parenting interventions in childhood to cascade over time to affect health-related outcomes in emerging adulthood.

Psychometric properties of the generalized anxiety disorder questionnaire (GAD-7) in a polish postpartum women sample

ObjectiveGeneralized Anxiety Disorder is an international mental health problem. Prevalence for anxiety disorders reported in perinatal period is high and related with adverse parental and child outcomes. Thus, the objective of this study was to investigate the psychometric properties and factorial validity of General Anxiety Disorder-7 questionnaire (GAD-7) in the context of postpartum mothers.MethodsIn this cross-sectional study, 278 mothers (mean age 31.09; SD = 4.42) were recruited at the Neonatology, Gynecology, and Obstetrics Ward. Generalized Anxiety Disorder was assessed with GAD-7, stress with Parental Stress Scale (PSS), while risk of depression with Edinburgh Postpartum Depression Scale (EPDS). Confirmatory factor analysis (CFA) was used to verify factor structure of GAD-7 and the internal consistency was evaluated using reliability coefficients: Cronbach’s Alpha and McDonald’s Omega.ResultsThe internal consistency of the GAD-7 was high (Cronbach’s Alpha = 0.90 and MacDonald’s Omega = 0.91). GAD-7 had significant correlations with the variables examined for construct validity, stress (PSS; r = 0.35, p < 0.01) and risk of depression (EPDS; r = 0.76, p < 0.01). The Confirmatory Factor Analysis results supported a good fit of the data to the model: χ²(df) = 14.19 (14), p = 0.44; Comparative Fit Index (CFI) = 0.99; Tucker-Lewis Index (TLI) = 0.99; Root Mean Square Error of Approximation (RMSEA) = 0.007 (90% C.I. 0.000; 0.059).ConclusionGAD-7 has satisfactory psychometric properties. GAD-7 had significant correlations with the variables examined for construct validity with PSS and EPDS. GAD-7 is a reliable instrument for screening anxiety symptoms in perinatal period in research and clinical setting.

Parent Views on Parent and Child-reported Outcomes in Pediatric Advanced Cancer: A Qualitative Study

BackgroundResearch on concurrent parent and patient-reported outcomes has primarily focused on reaching agreement. However, little is known about how to interpret and address discrepancies, which are not uncommon, between both viewpoints. ObjectivesTo explore parents' perspectives on reporting about child symptoms and quality of life (QoL) concurrently with their child in the context of pediatric advanced cancer. MethodsThis qualitative study was embedded in the PediQUEST Response Study, a randomized controlled trial of timely palliative care integration in children with advanced cancer. Over 18 weeks, study dyads (children ≥5 years old and one parent) completed weekly e-PROs assessing symptoms and QoL. Using a grounded theory approach, we ran a secondary analysis of end-of-study semi-structured parent interviews to examine their views on concurrent reporting of symptoms. ResultsOut of 110 randomized dyads included in this analysis, 77 parents completed an exit interview. Most were White non-Hispanic mothers. Parent reflections on concurrent reporting of child symptoms and QoL are summarized in the following themes: symptom experience is subjective, parent and child viewpoints are unique, parents ask fewer questions as they adapt to child treatment, and children may hesitate to share symptoms. To better grasp their child's experience, parents developed proactive communication strategies. ConclusionInterviewed parents acknowledged that parent report and child self-report are distinct and complementary. Their perspectives provide guidance to clinicians and researchers about the implementation and interpretation of concurrent outcomes measurement in pediatric advanced cancer care.Clinicaltrials.gov NCT03408314.

Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial

Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children. This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2-3h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1-4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529. From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43)=21.47, p<0.0001, ηp 2=0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support. A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited. Emerging Researcher First Grant from the Health Research Council of New Zealand.