Parental Responses Research Articles

A Mixed-methods Examination of Culturally Responsive Adaptation to an Evidence-based Parent-mediated Intervention Implemented for Autistic Children.

Parent-mediated interventions (PMIs) are considered an evidence-based practice for fostering social communication skills in young autistic children and for promoting parent responsivity and empowerment, yet barriers to caregiver engagement are evident when PMIs are implemented within historically underserved community settings. Issues of caregiver engagement can reflect a lack of fit between PMIs and the needs of diverse families. We used a mixed methods approach to examine barriers to participating in an evidence-based PMI, Project ImPACT (Ingersoll & Dvortcsak, 2019), within an outpatient setting, as well as strategies that clinicians reported using to deliver and adapt Project ImPACT for minoritized families. Participants included 134 caregivers of a child 13 to 48 months with autism or other social communication differences and six clinicians delivering Project ImPACT. Findings suggest that caregivers experience barriers to participating in Project ImPACT and that these barriers are associated with caregivers' ability to complete the program. Although quantitative findings indicate that adaptation to Project ImPACT did not differ by caregiver and child background, qualitative findings highlighted that clinicians attempt to deliver Project ImPACT to respond to the needs of families from minoritized backgrounds by actively considering the family's culture, psychosocial experiences, goals, and specific barriers. Further, both qualitative and quantitative findings suggest that culturally responsive care and adaptations may support caregiver engagement, including rapport, trust, buy-in, and attendance. Approaches to center cultural alongside contextual/psychosocial considerations within family-centered care in the implementation of PMIs are also highlighted.

Exploring Factors Affecting Parental Psychological Vulnerability During Their Child's PICU Admission: A Prospective Pilot Cohort Study

Parental psychological responses during their child's pediatric intensive care unit (PICU) admission are often overlooked. This study aimed to identify pre-existing and peri-traumatic factors explaining parental stress and anxiety during their child's PICU admission and one-month follow-up. A prospective pilot study included 60 PICU parents. Parental Stressors Scale and State-trait Anxiety Inventory measured stress and anxiety during PICU admission, and the State-trait Anxiety Inventory and Perceived Stress Scale at a one-month follow-up. During PICU admission, parental stress correlated with age, race, and adverse childhood experiences (ACEs), anxiety was linked to income. At one-month follow-up, anxiety related to child's health worries, perceived stress was linked to parental ACEs and education. Parental ACEs predicted perceived stress (b=0.83, p=.028). Children's diagnoses explained anxiety, particularly respiratory and cardiac diagnoses (b=-13.44, p=.023; -10.03, p=.045). Identifying factors helps teams understand parental vulnerability and provide appropriate support.

Function of juvenile plumage in the northern goshawk (Accipiter gentilis): aggressive mimicry hypothesis

Multiple raptors show juvenile plumage that is substantially different from that of their parents. Here, we test the prediction that the colouration of the juvenile northern goshawk Accipiter gentilis resembling the colouration of the common buzzard Buteo buteo acts as a form of aggressive mimicry. The goshawk specialises in hunting larger birds and mammals up to the size of geese or hares, while the buzzard preys mostly on small rodents. Larger birds may thus consider juvenile goshawks as less dangerous raptors, and the juvenile goshawk may thus gain an advantage when hunting. We used the Eurasian magpie Pica pica, a common prey of the goshawk, to test this prediction. We compared the behavioural responses of magpie parents defending their freshly fledged young towards mounts of an adult goshawk, juvenile goshawk, and buzzard. To be able to assess whether this behaviour differs from responses to a nest predator and a harmless bird we also presented a common raven Corvus corax and common pheasant Phasianus colchicus as baseline stimuli. Both juvenile and adult goshawks elicited antipredatory behaviour, but magpies took more risks facing juvenile goshawks. Additionally, the intensity of antipredatory behaviour towards the juvenile goshawk was also higher than towards the buzzard. We thus conclude that magpies do distinguish between juvenile and adult goshawks, as well as they do distinguish juvenile goshawks from buzzards. They are able to assess the threat particular raptors represent and respond accordingly. Analysis of spectral reflectance of stuffed specimens of these three raptors suggests there are differences, which can be used for the appropriate recognition. In conclusion, we cannot confirm the hypothesis of aggressive mimicry in juvenile goshawks that interact with magpies.

Prevalence of intellectual disability among adults born in the 1980s and 1990s in the United States.

Prevalence of intellectual disability (ID) is currently estimated through parent report on surveys of children. It is difficult to estimate the number of adults living with ID in the United States because no comprehensive survey or surveillance allows for identification. The purpose of this study was to estimate the prevalence and number of adults with ID born between 1980 and 1999 using multiple years of the National Health Interview Survey (NHIS) and Census data. We concatenated the NHIS from 1997-2016 that evaluated parental response about whether a child aged 3-17years had an ID. Using weighted survey analyses, we estimated the prevalence of ID among individuals across four birth cohorts-(1) 1980-1984, (2) 1985-1989, (3) 1990-1994, and (4) 1995-1999. The number of adults with ID was then extrapolated by applying these prevalence rates to Census population estimates (as of 1 July 2021) of respective birth cohorts. Weighted prevalence of ID varied by birth cohort, sex, race and ethnicity, and US Census Bureau regions. The overall prevalence rate was 1.066 [95% confidence interval (CI): 0.831-1.302] for adults born between 1980 and 1984, 0.772 (CI: 0.654-0.891) for adults born between 1985 and 1989, 0.774 (0.675-0.874) for adults born between 1990 and 1994, and 1.069 (CI: 0.898-1.240) for adults born between 1995 and 1999. Overall, we estimate that 818564 adults with ID who were approximately 21-41years were living in the United States as of 2021. This study provides researchers examining adult health outcomes with an estimated denominator of young and middle-aged adults living with ID in the United States. Policymakers can use this information to support justification for resource and service needs, and clinicians may benefit from understanding that ID is a lifelong developmental condition often with additional physical, emotional and developmental needs requiring tailored care.

Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study.

Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children's acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care-based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care.

Mindfulness-enhanced parenting programmes for improving the psychosocial outcomes of children (0 to 18 years) and their parents.

Mindfulness-enhanced parenting programmes for improving the psychosocial outcomes of children (0 to 18 years) and their parents.

"I want to be there. I have to be there.": Parents' perceived barriers and facilitators to bedside presence in the pediatric intensive care unit.

Parental presence at the bedside during a stressful pediatric intensive care unit (PICU) admission may improve child comfort, reduce parental anxiety, and enable family engagement. We performed this study to identify factors that parents perceive impact their capability, opportunity, and motivation to be at the bedside in PICU. We conducted a qualitative descriptive study using semi-structured interviews based on the Theoretical Domains Framework (TDF). We included parents of children admitted to the PICU for at least 24 h at IWK Health in Nova Scotia, Canada. Interviews were coded independently by two researchers using a directed content approach based on the TDF. We generated themes and subthemes, with the subthemes identified as factors impacting parental presence, and assigned TDF domains to each of the subthemes. Fourteen primary caregivers (8 mother figures, 6 father figures) participated in 11 interviews. The factors associated with parental presence were captured by 6 themes: Understanding the Medicalized Child; Maintaining the Parent Role; Life Beyond the Hospital; Parental Intrinsic Responses and Coping; Support Structures; and The PICU Environment. Fifty-two barriers and enablers were identified within 13 TDF domains; 10 TDF domains were determined to be relevant to parental presence, which may be used to guide design of future interventions. Participants emphasized the importance of self-care to enable them to remain physically at their child's bedside and to be engaged in their care. Parents perceive multiple factors within 6 themes act as barriers or enablers to presence with their critically ill child in the PICU. Guided by relevant TDF domains, interventions may be designed to optimize presence, particularly engaged presence, which may improve health-related outcomes of children and their parents.

Racial differences in parent response to COVID schooling policies.

This paper examines whether school COVID-19 policies influenced enrollment differently by student age and race/ethnicity. Unlike much prior research, we i) analyze enrollments for virtually the entire U.S. public school population for both the 2020-2021 and 2021-2022 school years, ii) compare enrollment trends within districts in order to isolate subgroup heterogeneity from district characteristics, and iii) account for district selection into preferred learning modes. Analyzing data on over 9,000 districts that serve more than 90% of public school students in the United States, we find enrollment responses to COVID policies differed notably. We find that White enrollments declined more than Black, Hispanic, and Asian enrollments in districts that started the 2020-2021 school year virtually, but in districts that started in-person the reverse was true: Non-White enrollments declined more than White enrollments. Moreover, Black, Hispanic, and Asian families responded more than White families to higher COVID-19 death rates in the months preceding the start of the 2021 school year. In 2021-2022, enrollment differences by the previous year's learning mode persisted. Racial/ethnic differences did not vary by whether the district required masking in classrooms. These findings are consistent with the greater risk faced by communities of color during the pandemic and demonstrate an additional source of disparate impact from COVID policies.

Parental and School Responses to Student Performance: Evidence from School Entry Rules

Parental and School Responses to Student Performance: Evidence from School Entry Rules

Parental and School Responses to Student Performance: Evidence from School Entry Rules

Parental and School Responses to Student Performance: Evidence from School Entry Rules

Diagnostic Evaluation of Autism Spectrum Disorder in Pediatric Primary Care.

Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD.

Parental Contingent Verbal Response to Early Vocalizations of Simultaneous Bilateral Cochlear Implantees

Objectives: The parental verbal response greatly influences infants’ speech-language development in early communication. This study aimed to investigate the features of parental verbal responses in infants who have undergone simultaneous bilateral cochlear implantation compared to chronological age-matched (CA) and hearing age-matched (HA) children who have typical hearing.Methods: Thirteen pairs of infants with cochlear implants (CIs) and their parents, 13 pairs of CA infants and their parents, and 13 pairs of HA infants and their parents participated in this study. The parent-infant interaction task was conducted in a free-play situation. Infants’ vocalizations were classified into canonical and non-canonical vocalizations. Parental verbal responses were divided into parental contingent responses (PCRs), parental non-contingent responses (PNCRs), and no response (NR). PCRs were divided into the language expectant and language non-expectant responses.Results: There was no significant difference in the ratio of parental verbal responses between the three groups. The ratio of parental verbal responses to non-canonical vocalizations was higher than parental verbal responses to canonical vocalizations. Additionally, the ratio of PCRs was higher than that of PNCRs and NR, and the ratio of language expectant responses was higher than that of language non-expectant responses. However, the ratio of language development responses to non-canonical vocalizations is similar to that of canonical vocalizations in the CI group.Conclusion: Parents of the simultaneous bilateral CI group tend to respond quickly and sensitively to the vocalization of infants’ vocalizations. Parents in the CI group can adjust their language based on their infant’s vocalization and development. These findings can guide early intervention and coaching for parents of infants with CIs.

A Comparative Study on Visual Attention, Verbal Engagement and Parental Behaviors During Shared Book Reading Using Scripted and Unscripted Story Books for Children with Autism Spectrum Disorder

Purpose: Shared book reading is nowadays considered as an important early language stimulation technique in the field of speech language pathology which encourages parent-child bonding and creates a conducive environment for language development. The parent-child interaction is important for a child with Autism Spectrum Disorder. This interaction along with adequate and contingent parental responses fosters early language development in children. Language-related parent behaviors promote children’s oral language skills by not only exposing the child to book-related vocabulary (e.g., labeling pictures, explaining word meanings, and linking words to everyday events), but also through explicit teaching of meaning-related skills related to the overall structure of the story (i.e., story grammar). Print-related SBR behaviors draw the child’s attention to print-related features of the book, for example, letter names and sounds.Methods: To better understand the relationship between children’s visual attention, verbal engagement and parent shared book reading behaviors during shared book reading tasks, this study included 10 preschoolers on the Autism Spectrum and their parents sharing an unfamiliar storybook including which are scripted and unscripted. Videos of the shared book reading interactions were transcribed and coded for visual attention, verbal engagement and parent behaviors using observational coding schemes. The frequency of visual attention, verbal engagement and parental SBR behaviors were compared between the scripted and unscripted story books using statistical tests-Wilcoxon signed rank test and Fisher’s Exact test.Results: Result reveals that there was no statistically significant difference between frequency of visual attention during unscripted story books and scripted books. Parental behaviors parameters pertaining to shared book reading were analyzed and found a significant difference in usage of book language is greater for scripted story books compared to unscripted books.Conclusions: The key findings shows the type of book (scripted or unscripted) have a significant impact and its contribution to the intervention of children with Autism Spectrum Disorder. Parental SBR behaviors can in turn contribute to the development of childhood language and preliteracy skills.

The Positive Impact of Parental Autonomy Support, Academic Socialization, Parental Responses, and Psychological Control on Muslim Students' Motivation

The encouragement of autonomy in academics is one strategy to encourage students to continue their education. Academic autonomous motivation can be generated through support relationships from the school environment and parents. This study aimed to determine the extent of prediction of autonomy, control, academic socialization, and parental response on academic scores to the academic autonomous motivation of 569 State MTs students in Sleman Regency. Data analysis was performed using Multiple Linear Regression Analysis techniques. The test results showed that three of the six tested relationships were significant, and the other three variables were insignificant. The variables parental autonomy support, behavior control, and response without punishment had a substantial relationship with students' academic autonomous motivation. Insignificant relationships were the relationship of psychological control with academic autonomous motivation, the academic socialization of students with academic autonomous motivation, and the relationship of non-punitive response with academic autonomous motivation. Research related to academic autonomous motivation with parental care is still limited, so further research is needed.

Behavioural response of parents and children with autism and developmental disorders in times of uncertainty: a Malaysian experience

Introduction Children and families with neurodevelopmental conditions have more difficulty coping with changes compared to peers. This study investigated the emotional/behavioural responses of children with autism spectrum disorder (ASD) and developmental disorders, and their families during the early stages of COVID-19 lockdown and identified the predictive factors. Methods Data from 265 children, 4–17 years, with ASD, other developmental disorders and typically developing children that include parent-rated questionnaires of emotion/behaviour, behaviour change, and parents’ level of stress were collected. We compared the mean scores of both clinical groups with typical developing children using Cohen’s d and determined the factors predictive of emotional/behavioural difficulties using logistic regression. Results Children with ASD experienced the most emotional/behavioural difficulties and behaviour deterioration during the early phase of COVID-19 lockdown. Parents from all groups reported comparable stress levels. Children with a diagnosis of ASD had a 3-fold increase in odds of emotional/behavioural difficulties (OR= 3.11; 95% 1.60–6.03, p < 0.001). A weaker association was observed with older age (13–17 years) (OR = 2.28; 95% CI 0.96–5.38, p = 0.056). Correlation analysis showed that parents’ stress levels were positively associated with children’s emotion/behaviour scores and behaviour deterioration. Conclusions Family-centred approaches are a priority to recognise vulnerable families and provide support during times of crisis.

Common caregiver illness representations in the context of family-based treatment: Commentary on Marchetti and Sawrikar (2023).

In their systematic review on parent illness representations in their children with anorexia nervosa (AN), Marchetti and Sawrikar (International Journal of Eating Disorders, 2023) integrate past research on the parental experience of the illness, investigating whether the Common Sense Model of Self-Regulation (CSM) is a useful framework for understanding parental responses to AN. Given that family-based treatment (FBT) is a first-line treatment for adolescents with eating disorders and is based upon integrating parents into the treatment process, it is especially relevant to explore how parent illness representations may impact FBT. In this commentary, we describe how FBT is designed to support parents and address many of the common unhelpful beliefs and emotions associated with parenting an adolescent with AN. We include specific examples of how parents can be supported within FBT as manualized. We also examine parental representations that may not be addressed by FBT, and how these may impact treatment outcomes in FBT, possibly via the impact of expressed emotion. Future research is needed to determine if modifications to FBT are required to address parental representations of the illness. We end by expanding upon Marchetti and Sawrikar's suggestions on how treatment could be extended to better support parents as necessary.

Parent attitudes and perceptions of integrated behavioral health care delivery for pediatric patients

Introduction: Patient access to high-quality behavioral health services has been a well-documented problem that has only been further complicated by the COVID-19 pandemic, especially within the pediatric population. Although integrated models of care have demonstrated efficacy for improving access, there is little research examining parents’ preferences for key elements of integrated practice, which now include increased utilization of virtual care. Parent/caregiver perspectives are essential to understand and enhance behavioral health service delivery within an integrated model of care because they are largely responsible for initiating, facilitating, and intimately participating in their children’s behavioral health care.&#x0D; Methods and Aims: The Parent Acceptance of Pediatric Integrated Care Survey Revised (PAPICS-R) was developed by a multidisciplinary panel of integrated care experts to evaluate caregiver perceptions of behavior health care delivery models for pediatric patients. A major component of the revised survey was a focus on virtual care, which has become ubiquitous since the beginning of the Covid-19 pandemic. Eight hundred thirty-four parents from diverse backgrounds across the United States who had children under 18-years old completed the revised survey online. Survey responses were analyzed using various statistical modeling techniques. Detailed demographic data was collected and associations of demographic variables with item responses were assessed using ANOVA and Chi-square tests.&#x0D; Results: Results indicated parent support for core components of integrated care such as co-location of medical and behavioral health care, interactive communication between providers, and shared access to health records. Parents also tended to prefer to be involved in their child’s therapy and indicated acceptability of virtual behavioral health care. Significant differences in parent responses were evident across several demographic variables such as race/ethnicity, parent age, child age, number of children and parent education. Notably, patient privacy and stigma were primary concerns for certain groups. These key findings will be shared to explore how specific demographic differences affect parent integrated care perspectives and how best to address these differences in practice.&#x0D; Conclusions: Results from the PAPICS-R provide valuable insight into parent perceptions of integrated behavioral health care. Notably, parent attitudes toward the integrated model of care (including virtual healthcare delivery methods) are largely positive. The findings have directly impacted multiple key aspects of the IBH program including future format of care delivery, trainee education, program expansion, and quality improvement. These adaptations will be discussed along with broader implications.&#x0D; Future Directions: Additional data are being gathered to examine the impact of various parent demographic variables on perspectives of an integrated primary care model. We are also currently working to disseminate results from the PAPICS-R survey to health care providers and organizations as the data are expected to provide valuable insight for those looking to establish integrated pediatric primary care clinics or improve their current model of care. Applicability of implementation within a diverse range of communities and regions will be discussed.&#x0D;

Parent‐child contact problems: Family violence and parental alienating behaviors either/or, neither/nor, both/and, one in the same?

AbstractThis article argues that in order to intervene effectively and ethically with children who are manifesting Parent–child contact problems (PCCPs) after parental separation, we begin by being mindful of what is normal about divorce transitions and use developmentally appropriate and culturally sensitive analysis to rule out children's common transitory reactions. It is then important to concurrently assess for both family violence (FV) and severe parental alienating behavior (PAB) on the part of both parents, which can co‐occur in some cases. The article asserts that it is also important to consider common problematic parenting responses that may potentiate the PCCP but not necessarily rise to the level of abuse. FV is defined as a child's direct experience of physical, sexual, or psychological maltreatment and indirect exposure to sibling abuse and/or to intimate partner violence (IPV). PAB is defined as an ongoing pattern of unwarranted negative messages on the part of one parent that conveys that the child's other parent is disinterested, irrelevant, dangerous, and not to be trusted. Any one or all of these factors may contribute to a child's strident negativity and sustained rejection of one parent, these being defining features of a PCCP. This article proposes ethical principles and priorities for decision‐making in these cases, considering the growing social science controversy about assessment and intervention for PCCPs. It concludes with an analysis of recent, contrasting policy approaches to PCCPs (e.g., Kayden's Law and the Joint Statement of the AFCC and NCJFCJ) and their potential impact on family justice system professionals and the families they serve.

Parental engagement enhanced: The response of parents in a sample of Northern Ireland’s schools to the emergency remote teaching provided through two periods of school lockdown during the Covid-19 pandemic

Parental engagement enhanced: The response of parents in a sample of Northern Ireland’s schools to the emergency remote teaching provided through two periods of school lockdown during the Covid-19 pandemic

Parents' Perspectives of Augmentative and Alternative Communication: From Assessment to Implementation

Purpose: Parents are known to be effective communication partners in their children's augmentative and alternative communication (AAC) intervention. This study aimed to better understand the parent perspective in the AAC acquisition, implementation, and handing processes across various primary disability labels and ages. Method: Twenty-two parents of children who use AAC engaged in phone interviews to discuss their family's experiences with AAC obtainment and intervention. A thematic analysis of the interview data was conducted. Results: The following five themes emerged: assessment procedures, early recommendations for AAC, external variables that influence device access, supports and barriers parents face when navigating AAC use with their child, and what participants would do differently. Further subthemes were also established to categorize parent responses. Conclusions: Findings support the inclusion of family-centered care for children with complex communication needs who use AAC. Parent responses indicate a greater need for interprofessional communication between children's team members and their family to provide comprehensive support. Parents also emphasized a desire to introduce AAC earlier into their family.