Meredith A. Gruhn

Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review.

In this meta-analytic and narrative review, we examine several overarching issues related to the study of coping, emotion regulation, and internalizing and externalizing symptoms of psychopathology in childhood and adolescence, including the conceptualization and measurement of these constructs. We report a quantitative meta-analysis of 212 studies (N = 80,850 participants) that measured the associations between coping and emotion regulation with symptoms of internalizing and externalizing psychopathology. Within the meta-analysis we address the association of broad domains of coping and emotion regulation (e.g., total coping, emotion regulation), intermediate factors of coping and emotion regulation (e.g., primary control coping, secondary control coping), and specific coping and emotion regulation strategies (e.g., emotional expression, cognitive reappraisal) with internalizing and externalizing symptoms. For cross-sectional studies, which made up the majority of studies included, we examine 3 potential moderators: age, measure quality, and single versus multiple informants. Finally, we separately consider findings from longitudinal studies as these provide stronger tests of the effects. After accounting for publication bias, findings indicate that the broad domain of emotion regulation and adaptive coping and the factors of primary control coping and secondary control coping are related to lower levels of symptoms of psychopathology. Further, the domain of maladaptive coping, the factor of disengagement coping, and the strategies of emotional suppression, avoidance, and denial are related to higher levels of symptoms of psychopathology. Finally, we offer a critique of the current state of the field and outline an agenda for future research.

Good Cop, Bad Cop: Quality of Parental Involvement in Type 1 Diabetes Management in Youth

Sustained parental involvement in diabetes management has been generally advised to counteract the deteriorating adherence and glycemic control often seen during adolescence, yet until recently, little attention has been given to the optimal amount, type, and quality of parental involvement to promote the best health outcomes for adolescents with type 1 diabetes (T1D). This review synthesizes research regarding the involvement of caregivers—primarily mothers and fathers—of youth with T1D, with a focus on biopsychosocial outcomes. The recent literature on parental involvement in diabetes management highlights a shift in focus from not only amount but also the types (e.g., monitoring, problem-solving) and quality (e.g., warm, critical) of involvement in both mothers and fathers. We provide recommendations for ways that both parents can remain involved to facilitate greater collaboration in shared direct and indirect responsibility for diabetes care and improve outcomes in youth with T1D.

Testing specificity among parents' depressive symptoms, parenting, and child internalizing and externalizing symptoms.

The present study examined the specificity in relations between observed withdrawn and intrusive parenting behaviors and childrens internalizing and externalizing symptoms in an at-risk sample of children (ages 9 to 15 years old) of parents with a history of depression (N = 180). Given past findings that parental depression and parenting behaviors may differentially impact boys and girls, gender was examined as a moderator of the relations between these factors and child adjustment. Correlation and linear regression analyses showed that parental depressive symptoms were significantly related to withdrawn parenting for parents of boys and girls and to intrusive parenting for parents of boys only. When controlling for intrusive parenting, preliminary analyses demonstrated that parental depressive symptoms were significantly related to withdrawn parenting for parents of boys, and this association approached significance for parents of girls. Specificity analyses yielded that, when controlling for the other type of problem (i.e., internalizing or externalizing), withdrawn parenting specifically predicted externalizing problems but not internalizing problems in girls. No evidence of specificity was found for boys in this sample, suggesting that impaired parenting behaviors are diffusely related to both internalizing and externalizing symptoms for boys. Overall, results highlight the importance of accounting for child gender and suggest that targeting improvement in parenting behaviors and the reduction of depressive symptoms in interventions with parents with a history of depression may have potential to reduce internalizing and externalizing problems in this high-risk population.

Stress, coping, executive function, and brain activation in adolescent offspring of depressed and nondepressed mothers

ABSTRACT This study examined the associations among chronic stress, activation in the prefrontal cortex (PFC), executive function, and coping with stress in at-risk and a comparison sample of adolescents. Adolescents (N = 16; age 12–15) of mothers with (n = 8) and without (n = 8) a history of depression completed questionnaires, neurocognitive testing, and functional neuroimaging in response to a working memory task (N-back). Children of depressed mothers demonstrated less activation in the anterior PFC (APFC) and both greater and less activation than controls in distinct areas within the dorsal anterior cingulate cortex (dACC) in response to the N-back task. Across both groups, activation of the dorsolateral PFC (DLPFC; Brodmann area [BA9]) and APFC (BA10) was positively correlated with greater exposure to stress and negatively correlated with secondary control coping. Similarly, activation of the dACC (BA32) was negatively correlated with secondary control coping. Regression analyses revealed that DLPFC, dACC, and APFC activation were significant predictors of adolescents’ reports of their use of secondary control coping and accounted for the effects of stress exposure on adolescents’ coping. This study provides evidence that chronic stress may impact coping through its effects on the brain regions responsible for executive functions foundational to adaptive coping skills.

Parental Depressive Symptoms and Parenting: Associations with Children’s Coping in Families of Depressed Parents

SYNOPSIS Objective. This multi-method study examined parental depressive symptoms and levels of harsh/intrusive and warm/responsive parenting as correlates of secondary control coping (acceptance, cognitive reappraisal, distraction) in children of parents with a history of depression. Design. The sample included 165 parents with a history of major depressive disorder and their 9- to 15-year-old children. Parents provided self-reports of their current depressive symptoms; videorecordings of parent–child interactions were coded to determine parenting behaviors; and children reported their use of secondary control coping strategies. Results. Harsh/intrusive parenting related to less, and warm/responsive parenting related to greater, use of secondary control coping strategies in children. Parents’ current depressive symptoms were only conditionally related to children’s use of secondary control coping strategies, such that depressive symptoms moderated the relation between warm/responsive parenting behaviors and child secondary control coping. When parental depressive symptoms were low or average, warm/responsive parenting was positively related to children’s secondary control coping. When parental depressive symptoms were high, warm/responsive parenting was not associated with children’s secondary control coping. Conclusions. The association between positive parenting behaviors and children’s coping is contingent on current levels of parents’ depressive symptoms. Efforts to enhance children’s coping skills should target both parental depressive symptoms and parenting skills.

Trajectories of child and caregiver psychological adjustment in families of children with cancer.

Objective: To describe the trajectory of patient and caregiver mental health from diagnosis through the first year of treatment for pediatric cancer and assess whether rates of clinically relevant symptoms were elevated compared with norms. We examined mean levels of internalizing and externalizing symptoms and posttraumatic stress symptoms (PTSS) in children with cancer, and depression, anxiety, and PTSS in caregivers during the first year of treatment; the proportion of patients and caregivers that scored in the clinical range at each time point; and the typical trajectory of symptoms in patients and caregivers and whether trajectories differed between individuals. Method: Families (N = 159) of children newly diagnosed with cancer (Mage = 5.6 years; range = 2–18 years) participated in a short-term prospective study. Primary caregivers provided monthly reports of their own and their children’s psychological adjustment. Results: On average, children were well-adjusted. However, compared with norms, there was a higher than expected proportion of children with clinically relevant internalizing symptoms around the time of diagnosis. On average children’s symptoms declined over time, though variability was observed. Caregivers were less well-adjusted on average, with a high proportion reporting clinically relevant symptoms over time for depression and anxiety. Caregiver symptoms also declined over time, though considerable variability was observed. Conclusion: Although most children remain well-adjusted during the first year of treatment, many caregivers experience clinically relevant symptoms of psychological distress. Implications for development of interventions targeting at-risk patients and caregivers are discussed. Identifying processes that predict between-family variability in trajectories of psychopathology is an important next step.

Developing and testing an intervention to reduce distress in mothers of adolescents with Type 1 diabetes.

The purpose of this study was to develop and pilot test a program to meet the needs of mothers of adolescents with Type 1 diabetes (T1D) and to improve outcomes in adolescents with T1D. We conducted focus groups with mothers of adolescents to identify needs and develop a cognitive–behavioral intervention aimed at reducing maternal distress, improving parenting practices, and reducing family conflict. This intervention was pilot tested in a randomized trial; mothers were randomized to either the Coping & Communication (N = 15) intervention or Usual Care (N = 15). Mothers and adolescents completed questionnaires measuring distress, parenting, and family conflict pre- and postintervention, and HbA1c values were obtained from adolescents’ medical records pre- and postintervention. Intervention materials (Communication & Coping) received high scores on health literacy and engagement. There was a significant Time × Group interaction for maternal diabetes distress, family conflict (as reported by both mothers and adolescents), and adolescent quality of life. Mothers and adolescents randomized to the intervention group reported significant improvements on these factors as compared with those randomized to usual care. The Communication & Coping program was developed by adapting existing interventions proven to reduce depressive symptoms and improve parenting practices to address the specific needs of mothers of adolescents with T1D. The program shows promise for not only reducing distress in mothers, but also for improving adolescent outcomes, possibly through reductions in family conflict.

Parent reports of children’s working memory, coping, and emotional/behavioral adjustment in pediatric brain tumor patients: A pilot study

ABSTRACT Neurocognitive problems in childhood survivors of brain tumors are well documented. Further, research has shown that problems in cognitive functioning may be associated with impairment in the use of complex strategies needed to cope with stress, including secondary control coping strategies (e.g., acceptance and cognitive reappraisal) which have been associated with fewer adjustment problems. The present study measured cognitive function, coping strategies, and adjustment in children ages 6–16 years at the time of brain tumor diagnosis and at two follow-up time-points up to 1 year post-diagnosis. In a prospective design, working memory was assessed in a total of 29 pediatric brain tumor patients prior to undergoing surgery, child self-reported coping was assessed at 6 months post-diagnosis, and parent-reported child adjustment was assessed at 12 months post-diagnosis. Significant correlations were found between working memory difficulties and secondary control coping. Secondary control coping was also negatively correlated with child attention and total problems. Regression analyses did not support secondary control coping mediating the association between working memory difficulties and child attention or total problems. These findings represent the first longitudinal assessment of the association between working memory, coping, and adjustment across the first year of a child’s brain tumor diagnosis and suggest a possible role for early interventions addressing both working memory difficulties and coping in children with brain tumors.