Marcia A. Winter

Pathways between profiles of family functioning, child security in the interparental subsystem, and child psychological problems

This study was designed to delineate pathways between systems profiles of family functioning, childrens emotional insecurity in the interparental relationship, and their psychological adjustment in a sample of 221 children and their parents. Consistent with family systems theory, cluster analyses conducted with assessments of marital, coparental, and parent-child functioning indicated that families fit into one of four profiles: (a) cohesive families, characterized by warmth, affection, and flexible well-defined boundaries in family relationships; (b) disengaged families, reflected in high levels of adversity and low levels of support across family subsystems; (c) enmeshed families, evidenced by high levels of discord and weak maintenance of relationship boundaries in the family unit; and (d) adequate families, defined by elevated parental psychological control within a larger family context of low discord and high warmth. In comparison to children in cohesive families, children in enmeshed and disengaged families exhibited greater signs of insecurity in the interparental relationship concurrently and internalizing and externalizing symptoms both concurrently and 1 year later. Structural equation models revealed that a latent, multimethod measure of insecurity in the interparental relationship partially mediated associations between family enmeshment and disengagement and childrens psychological symptoms 1 year later. Results are discussed in relation to how they inform and refine a family-wide model of the emotional security hypothesis.

The implications of emotional security theory for understanding and treating childhood psychopathology.

Understanding why interparental difficulties pose a risk to children in families experiencing domestic violence is an urgent task for ameliorating childhood psychopathology, particularly in light of the paucity of knowledge on the unfolding mediating mechanisms and the potentiating and protective conditions that underlie the multiplicity of pathways between domestic violence and child maladjustment. Toward addressing this significant gap, this paper examines how the emotional security theory (EST) may foster advances in our understanding of the genesis, course, and treatment of childrens psychological problems in families experiencing domestic violence. Following an overview of the theoretical assumptions and significance of translating the emotional security theory to high-risk contexts, we address how childrens difficulties in preserving security may emerge in the face of domestic violence and accompanying forms of severe family adversity, and illustrate the implications of emotional insecurity for childhood psychopathology in homes characterized by domestic violences. In the final section, we address how the EST may be useful in informing public policy and intervention initiatives designed to reduce the burden of mental illness.

Interparental Conflict and Children’s School Adjustment: The Explanatory Role of Children’s Internal Representations of Interparental and Parent–Child Relationships

This study examined how childrens insecure internal representations of interparental and parent-child relationships served as explanatory mechanisms in multiple pathways linking interparental conflict and parent emotional unavailability with the emotional and classroom engagement difficulties the children had in their adjustment to school. With their parents, 229 kindergarten children (127 girls and 102 boys, mean age = 6.0 years, SD = .50, at Wave 1) participated in this multimethod, 3-year longitudinal investigation. Findings revealed that childrens insecure representations of the interparental relationship were a significant intervening mechanism in associations between observational ratings of interparental conflict and child and teacher reports on childrens emotional and classroom difficulties in school over a 2-year period. Moreover, increased parental emotional unavailability accompanying high levels of interparental conflict was associated with childrens insecure representations of the parent-child relationship and childrens difficulties in classroom engagement at school entry. The findings highlight the importance of understanding the intrinsic processes that contribute to difficulties with stage-salient tasks for children who are experiencing interparental discord.

Prenatal Maternal Anxiety Predicts Reduced Adaptive Immunity in Infants

Prenatal anxiety has been linked with altered immune function in offspring in animal studies, but the relevance for human health is unknown. We examined prenatal maternal anxiety as a predictor of adaptive immunity in infants at 2 and 6 months of age as part of a prospective longitudinal study. The humoral immune response to hepatitis B vaccine was assessed at 2 months (n=80) and 6 months (n=76) of age. Prenatal anxiety predicted lower hepatitis B antibody titers at 6 months of age independent of obstetric and socio-demographic covariates; the effects were limited to those infants who had not completed the 3-dose vaccine series (for transformed titer values, r=-.36, p<.05). Cell-mediated immune responses at 2 (n=56) and 6 (n=54) months of age were examined by ELISpot assays for interferon(IFN)-γ, interleukin(IL)-2, and IL-4 responder cell frequencies to three antigens: hepatitis B surface antigen, tetanus toxoid, and phytohaemagglutinin (PHA). Prenatal maternal anxiety was associated with reduced IFN-γ and increased IL-4 responder cell frequencies at 6 months of age, independent of obstetric and socio-demographic covariates. No effect of prenatal anxiety was found on adaptive immunity at 2 months of age. The findings provide the first demonstration in humans that prenatal anxiety alters adaptive immunity in the infant.

Children’s Insecure Representations of the Interparental Relationship and Their School Adjustment: The Mediating Role of Attention Difficulties

This study examined the role of attention difficulties as a mediator of associations between childrens insecure representations of the interparental relationship and their school adjustment in a sample of two hundred and sixteen 6-year-old children. Consistent with hypotheses, findings from structural equation models indicated that observer ratings of childrens insecure representations of interparental relationships in a story completion task predicted computerized task assessments and parent reports of childrens attention difficulties 1 year later. Childrens attention difficulties, in turn, were associated with concurrent levels of school problems and increases in school problems over a 1-year period as indexed by teacher reports. Attention difficulties accounted for an average of 34% of the association between insecure internal representations and school problems.

Nighttime Waking in Children With Asthma: An Exploratory Study of Daily Fluctuations in Family Climate

Children with asthma are at increased risk for waking in the night, and there is the potential for the entire household to feel the effects. The authors conducted a telephone-based diary study to examine whether daily fluctuations in parent mood, parenting hassles, and family routines would distinguish nights in which waking occurred from nights in which they did not. Forty-seven families with a child with asthma were contacted 4 times a week every 3 months over a period of 1 year, resulting in 500 daily observations. Parent negative mood, perceived parenting hassles, and disruptions in bedtime routines were associated with increased odds that the child would wake in the middle of the night. Results underscore the importance of considering family climate in childrens disturbed sleep.

The ABCs of Family Mealtimes: Observational Lessons for Promoting Healthy Outcomes for Children With Persistent Asthma

Family mealtimes have the potential to promote healthy child development. This observational study of 200 family mealtimes examined the relation between child health in a group of children (ages 5 to 12) with persistent asthma and 3 dimensions of mealtime interaction: Action, Behavior Control, and Communication. Percent time spent in Action and Positive Communication varied by asthma severity, child quality of life, and sociodemographic variables. Positive communication during mealtimes predicted child quality of life. Significant interactions between demographic variables and behavior control suggested that higher levels of behavior control affected child quality of life in the context of lower maternal education. Guidance is offered for practitioners and policy makers toward promoting healthy family mealtimes as a public health priority.

Do family mealtime interactions mediate the association between asthma symptoms and separation anxiety

BACKGROUND Respiratory problems have been shown to be associated with the development of panic anxiety. Family members play an essential role for children to emotionally manage their symptoms. This study aimed to examine the relation between severity of respiratory symptoms in children with asthma and separation anxiety. Relying on direct observation of family interactions during a mealtime, a model is tested whereby family interactions mediate the relation between asthma severity and separation anxiety symptoms. METHODS Sixty-three children (ages 9-12 years) with persistent asthma were interviewed via the Diagnostic Interview Schedule for Children IV; family interactions were assessed via direct observation of a mealtime; primary caregivers completed the Childhood Asthma Severity Scale; youth pulmonary function was ascertained with pre- and post-bronchodilator spirometry; adherence to asthma medications was objectively tracked for six weeks. RESULTS Poorer pulmonary function and higher functional asthma severity were related to higher numbers of separation anxiety symptoms. Controlling for medication adherence, family interaction patterns mediated the relationship between poorer pulmonary function and child separation anxiety symptoms. CONCLUSIONS Family mealtime interactions may be a mechanism by which respiratory disorders are associated with separation anxiety symptoms in children, potentially through increasing the childs capacity to cognitively frame asthma symptoms as less threatening, or through increasing the childs sense of security within their family relationships.

Asthma severity, child security, and child internalizing: using story stem techniques to assess the meaning children give to family and disease-specific events.

Children with persistent asthma are at increased risk for mental health problems. Although mechanisms of effect are not yet known, it may be that children are less trusting of the family as a source of support and security when they have more severe asthma. This study tested whether asthma severity is related to childrens perceptions of insecurity in the family, and whether insecurity is in turn associated with child adjustment. Children (N = 168; mean age = 8 years) completed story stems pertaining to routine family events (e.g., mealtimes) and ambiguous but potentially threatening asthma events such as tightness in the chest. Responses were evaluated for the extent to which appraisals portrayed the family as responding in cohesive, security-provoking ways. Asthma severity was assessed by both objective lung function testing and primary caregiver report. Caregivers reported child symptomatology. Beyond medication adherence, caregiver education, and child age and gender, greater asthma severity predicted more internalizing and externalizing symptoms. Greater asthma severity, assessed using spirometry (but not parent report), was related to less secure child narratives of the family, which in turn related to more child internalizing symptoms. Results suggest that asthma can take a considerable toll on childrens feelings of security and mental health. Furthermore, given the difficulty in assessing young childrens perceptions, this study helps demonstrate the potential of story stem techniques in assessing childrens appraisals of illness threat and management in the family.

Helpful Hints: Caregiver-Generated Asthma Management Strategies and Their Relation to Pediatric Asthma Symptoms and Quality of Life

OBJECTIVE This mixed-methods study examined the relation between caregiver-generated asthma management strategies and asthma severity in a sample of 200 children with persistent asthma (ages 5-12 years). METHODS Caregivers were interviewed about asthma management strategies they found helpful in controlling their childs symptoms. A qualitative content analysis was used to identify household strategies. Indicators of asthma severity included lung functioning (FEV(1)) and functional severity (FSS). Child quality of life was also assessed (PQLQ). RESULTS Six primary household strategies were identified: Reactive, Planning Ahead, Social, Emotional, Avoiding Triggers, and Cleaning. In general, strategies offered by caregivers did not differ by socioeconomic status. Caregivers who endorsed Avoiding Triggers as effective strategies had children with better lung functioning. Caregivers who endorsed Planning Ahead or Emotional strategies had children with better asthma-related quality of life. CONCLUSION These household strategies hold promise for reducing pediatric asthma symptoms and improving child quality of life.