Search Results (211)

Background/Objectives: HPV vaccination is safe, effective, and recommended at ages 11–12, yet uptake remains suboptimal. Serious video games may offer an innovative strategy to deliver brief, engaging education during clinic visits. This qualitative paper, embedded within a mixed-methods study, examined adolescents’, parents’, and healthcare providers’ (HCPs’) perceptions of the acceptability, usability, and perceived clinical applicability of HPV Detective, a tablet-based digital game designed to provide HPV-related education to parent–child dyads during pediatric clinic wait times. Methods: Eight adolescent–parent dyads (N = 16) and three HCPs from university-affiliated pediatric clinics participated in 30–60-min semi-structured Zoom interviews. Interviews were audio-recorded, transcribed, and thematically analyzed by two coders, with discrepancies resolved by consensus and reviewed by a third researcher. Results: Participants identified five key dyadic themes and four HCP themes. Adolescents described the gameplay as intuitive and enjoyable, highlighting interactive challenges and realistic avatars. Parents valued the clarity of HPV information and noted that the game helped initiate health-related conversations. Both adolescents and parents suggested enhancements including voice narration and greater customization and agreed that the game was well suited for 10–15-min clinic wait times, with text messaging preferred for follow-up. HCPs emphasized challenges such as parental hesitancy and competing clinical demands and viewed the game as a feasible adjunct to support vaccine-related discussions. Conclusions: Findings suggest the acceptability, usability, and perceived clinical applicability of a brief, clinic-based digital game for HPV-related education and engagement among adolescents and their parents. Full article

Background/Objectives: Childhood obesity remains a major public health issue, particularly in Mediterranean countries such as Greece. Although parental influences on children’s weight have been extensively studied, fewer studies have jointly examined parental mental health, feeding practices, sociodemographic factors, and biological stress markers. This study aimed to investigate associations between psychological status, educational level, feeding behaviors, and children’s Body Mass Index (BMI) in a Greek sample. A pilot assessment of salivary cortisol was included in evaluating its feasibility as an objective biomarker of parental stress. Subjects and Methods: A total of 103 parent–child dyads participated in this cross-sectional study. Children’s BMI was classified using World Health Organization (WHO) growth standards. Parental stress, anxiety, and depressive symptoms were assessed using the Perceived Stress Scale-14 (PSS-14) and the Depression Anxiety Stress Scale-21 (DASS-21) questionnaires. Feeding practices were evaluated with the Comprehensive Feeding Practices Questionnaire (CFPQ). Statistical analyses included Pearson correlations, independent samples t-tests, one-way ANOVA, Mann–Whitney U, and Kruskal–Wallis tests. A subsample provided saliva samples for cortisol analysis to assess feasibility and explore the potential associations with parental stress indicators. Results: Parental BMI showed a strong positive association with child BMI (p = 0.002). Higher parental anxiety (p = 0.002) and depression (p = 0.009) were also associated with increased child BMI. Restrictive (p < 0.001) and emotion-driven (p < 0.001) feeding practices were associated with higher child BMI, whereas monitoring (p = 0.013) and health-promoting feeding practices (p = 0.001) appeared protective. Lower parental education was related to a higher BMI in both parents (p = 0.001) and children (p = 0.002) and to more frequent use of restrictive feeding strategies (p = 0.001). WHO charts identified a greater proportion of children as overweight or obese compared with the Centers for Disease Control and Prevention (CDC) criteria. The analysis showed statistically significant differences between the two classification systems (χ² (4) = 159.704, p < 0.001), indicating that BMI categorization varies considerably depending on the reference system used. No significant associations were observed with residential environment or salivary cortisol, likely due to the limited size of the pilot biomarker subsample. Conclusions: The findings highlight the combined effect of parental mental health status, educational level, and feeding practices on child BMI within the Greek context. The preliminary inclusion of a biological stress marker provides added value to the existing research in this area. These results underscore the importance of prevention strategies that promote parental psychological wellbeing and responsive feeding practices while addressing socioeconomic disparities to reduce the childhood obesity risk. Full article

Family-implemented interventions are evidence-based practices used to support a range of developmental outcomes, including social communication. Social communication is a broad construct that encompasses a variety of skills, from foundational abilities such as joint attention (i.e., two people attending to the same object or event) to more advanced behaviors like triadic interactions (i.e., responding to or initiating conversation that involves reciprocal interactions). In a previous study, we examined the effects of a brief, parent-implemented Naturalistic Developmental Behavioral Intervention (NDBI), delivered over telepractice with video feedback coaching. The intervention resulted in increased strategy use by all mothers and the frequency of communication for three young children. In the current study, we conducted a secondary analysis of those data to explore whether the communication-focused intervention produced a collateral effect on activity-engaged triadic interactions (i.e., mother–child–mother or child–mother–child exchanges while simultaneously engaging in a joint activity). Although a functional relation was not established, critical theoretical implications are posed. These findings highlight the need for future research to break apart complex skills into subskills to detect any subtle changes in child outcomes. Limitations and directions for future research are discussed. Full article

The adult child–parent relationship is a key source of emotional support across adulthood and older age. This study takes a dyadic, attachment-based perspective to examine how (dis)similarities in attachment orientations between older parents and adult children relate to the emotional support they provide each other. A total of 104 adult child–parent dyads (M parents’ age = 67.85; M adult children’s age = 36.18) participated. Structural Equation Modeling (SEM) and Response Surface Analysis (RSA) were used to assess how dyadic (dis)similarities in attachment anxiety and avoidance are associated with own support provision. Both parents and adult children provided greater emotional support when their attachment insecurity was at low levels. Support also increased when the partner showed higher insecurity but differed across generations: parents offered more support when the child’s anxiety or avoidance exceeded their own, even at own high levels of insecurity, whereas children supported insecure parents only when their own insecurity was relatively low. Attachment-based processes in the adult child–parent bond serve as a source of emotional connection, operating differently across generations: parents can adapt caregiving to meet children’s needs, while children’s support is more constrained by their own attachment insecurity. Full article

Caregiver-mediated approaches in early intervention can provide impactful support for families of young children with social communication needs. Project ImPACT (PI), a caregiver-mediated naturalistic developmental behavioral intervention, was tested for effectiveness in public early intervention (EI) programs in a randomized waitlist-control community trial across California. Participants included EI service providers (n = 47) and caregiver–child dyads (n = 125; ages 14–32 months). Families received services-as-usual (SAU) or PI following provider training in PI. Multilevel models were used to examine provider coaching, caregiver–child interactions, caregiver PI strategy use, parenting stress, self-efficacy in parenting, and child social communication outcomes across approximately four months of services. Provider use of evidence-based coaching significantly improved after PI training. Caregivers who received PI showed greater gains in some domains of parent–child interaction; PI fidelity scores, stress, and self-efficacy did not differ by condition. Child communication outcomes improved over time in both groups, but differences between conditions were not detected during the study time period. Training community EI providers in PI improved coaching quality and enhanced caregiver–child interaction, demonstrating feasible, scalable use of PI in community settings. Differential child-level effects were not detected, underscoring the need for larger samples and longitudinal follow-up. Full article

Background/Objectives: Feeding difficulties in childhood can persist over time, affecting health and family dynamics. Timely identification is crucial to prevent atypical eating behaviors and nutrition-related consequences. However, data on childhood feeding difficulties remain limited. This study provides the first pilot characterization of eating behaviors among Italian children aged 5–11 years in order to characterize feeding difficulties, identify protective or detrimental factors, and assess relationships with anthropometric indices or blood pressure. Methods: In 2023, a 1-year cross-sectional pilot study was launched by the Società Italiana delle Cure Primarie Pediatriche involving child–parent dyads. Family pediatricians collected anthropometric data and blood pressure, after which parents completed an online questionnaire purposely developed for this study. The questionnaire generated a feeding difficulty score (0–10) where higher values reflected greater risk of atypical eating behaviors. Scores were categorized as follows: low risk (0–1), intermediate risk (2–6), and high risk (7–10). Results: A total of 742 questionnaires were collected. Overall, 19.8% of the children were categorized as high risk (7–10) for atypical behavior, 43.8% as intermediate risk (2–6), and 36.4% as low risk (0–1). Children with two omnivorous parents showed significantly lower odds of feeding difficulty scores at or above any threshold (OR 0.46, 95% CI 0.30–0.71; p < 0.0001). Borderline associations were observed for a breastfeeding duration of at least 9 months (OR 0.79, 95% CI 0.61–1.02; p = 0.075) and baby-led weaning (OR 0.72, 95% CI 0.52–1.00; p = 0.053). High-risk children had a significantly lower BMI percentile with respect to the other groups. Conclusions: A significant proportion of Italian children aged 5–11 years exhibited moderate to severe risk of atypical behaviors. Parental eating appears to play a key role in shaping children’s eating behaviors in middle childhood, underscoring the pivotal role of pediatricians in guiding families. Further research and targeted strategies are needed to prevent childhood feeding difficulties. Full article

Background/Objectives: Children with inflammatory bowel disease (IBD) are managed with multi-modal treatment strategies, including non-clinical components such as the development of self-management skills. Assessment tools have been developed to quantify such traits, and parents may be asked to provide proxy reports on behalf of their child. The aim of this study was for child/parent dyads to complete a self-management skills assessment tool [IBD-STAR] to assess the agreement level between reports. Methods: Children aged ≥10 years with IBD, and one parent/caregiver, were recruited from three tertiary care centers in New Zealand, Australia, and Italy [translated version]. IBD-STAR is scored as completing skills independently [score = 2], with help [score = 1], or not at all [score = 0]. Individual agreement was assessed as a proportion of the maximum agreement on items, category agreement as inter-rater reliability using Gwets AC1 coefficient, and aggregate agreement as a Bland–Altman plot and correlations between child/parent percentage scores. Results: Fifty child/parent dyads participated; child mean age of 14.5 years (±2.4), 31 (62%) female, and 31 (62%) had Crohn’s disease and 19 (38%) ulcerative colitis. At the individual level, the mean proportional agreement was 0.70 (±0.15), equating to complete agreement on ≥12 IBD-STAR items. Category agreement was in the range of 44–94% for items, parents were more likely to underestimate self-management skills, and inter-rater reliability ranged from poor to very good for items, and ‘good’ overall. Aggregate agreement showed high correlation between child/parent % scores (R 0.77, p < 0.001, CI 0.63 to 0.87), and 47 (94%) of the pairs had % scores within two standard deviations of each other. No level of agreement was associated with any independent variable. Conclusions: Parental proxy reports of self-management skills using IBD-STAR had acceptable agreement. The trend towards parental underestimation should be considered when child self-report cannot be assessed. Full article

Background/Objectives: Early motherhood is a risk factor for the mother-child relationship during the perinatal period, implying that intrusive or withdrawn maternal behavior and possibly abusive behavior can have short- and long-term consequences for child development. Methods: This study aimed to evaluate the preliminary effectiveness of a short mentalization community video feedback intervention designed to improve maternal mentalization, maternal communication, and behavior quality of adolescent and young mothers. Twenty-six young and adolescent mother-infant dyads were recruited at an Italian outpatient hospital service for adolescent and young parents with a one-group pre-test/post-test design. The participants (n = 15) received four video feedback sessions focused on mentalization and affective communication. At 3 infant months, risk factors associated with young motherhood were assessed. At 3 infant months (pre-intervention) and 9 months (post-intervention), the quality of maternal communication and behavior has been evaluated with Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE), and maternal mind-mindedness was assessed. Results: At the end of the intervention, the results showed significant improvements in maternal communication quality and mind-mindedness, especially in decreasing disrupted maternal affective communication (p = 0.005) and non-attuned mind-mindedness comments (p = 0.005). Conclusions: This study highlighted good acceptance of the intervention in a public health context and the effectiveness of a short mentalization community video feedback intervention to improve maternal mind-mindedness and communication quality between young mothers and their infants. The preliminary findings of this pilot study could be useful for implementing similar interventions aimed at young parents in community contexts. Full article

Background/Objectives: Parental involvement is currently recommended by Italian national guidelines on autism spectrum disorder (ASD) intervention. However, research on the impact of parent-mediated interventions on parental skills and children’s outcomes in Italy is limited. This study evaluated the feasibility of delivering Parent-ESDM (Parent-mediated Early Start Denver Model), a well-supported Naturalistic Developmental Behavioral Intervention (NDBI) known to benefit parents’ well-being and children’s development, within an Italian healthcare service. Methods: Twenty parent–child dyads participated in weekly 1 h Parent-ESDM sessions for 6 months. Spontaneous parent–child interactions were assessed at baseline, mid-intervention, and post-intervention to examine parents’ use of NDBI strategies and changes in children’s core ASD behaviors. Results: Throughout the intervention, parents acquired a good level of fidelity in the use of NDBI strategies and children obtained significant improvements in core ASD behaviors. Conclusions: These preliminary findings support the feasibility of delivering a parent-mediated intervention within an Italian healthcare service. The positive trends observed provide a strong rationale for conducting controlled trials to more definitively evaluate this model and its potential adoption as a future standard practice. Full article

The goal of this study was to examine problem-solving processes of elementary-aged children (4th grade U.S., ages 9–10) and their parents as they applied themselves to hands-on science activities together, with the larger goal of studying how parents influence the development of children’s science inquiry skills. In this diverse group of families, which was approximately equally balanced in terms of ethnicity (Hispanic and non-Hispanic) and parent and child gender, the influence of parent language, dyad ethnicity, and dyad gender was examined while controlling for family socio-economic status. Four problem-solving processes were examined: writing a hypothesis, recording results, drawing/sketching the process, and writing an explanation of how or why a process worked. The study included 153 families in a metropolitan area in the southwestern U.S. (Phoenix, AZ), approximately balanced in terms of child and parent ethnicity and gender. Gender differences were not observed for any of the problem-solving processes. Differences in some problem-solving processes, especially for writing a hypothesis, were observed based on parent language and dyad ethnicity. Families employed the strategy of drawing/sketching out solutions with a similar level of detail, regardless of parent education, language, ethnicity, and gender. Thus, we propose the use of drawing/sketching in the elementary science classroom as a useful strategy for reaching a diverse audience of learners. Family socio-economic status (as measured by parent education and family income) was strongly associated with parent language and dyad ethnicity. Implications for these findings are discussed. Full article

Serine protease inhibitor A3 (SERPINA3), also called α-1-antichymotrypsin, is a serine protease involved in placental dysfunction. This study examines SERPINA3 polymorphisms and haplotypes for associations with maternal hypertensive disorders of pregnancy (HDPs) and preeclampsia with severe features (sPE) or Hemolysis, Elevated Liver Enzymes, and Low Platelet (HELLP) syndrome in mother–baby dyads (HDP) and mother–father–baby triads (sPE/HELLP). This retrospective case–control study examined two patient cohorts, HDPs and severe PE/HELLP syndrome. The HDP population included cases (n = 142) and controls (n = 168) of mother–baby dyads recruited from a large, urban, safety-net hospital in Los Angeles. The sPE/HELLP syndrome population included cases (n = 189) and controls (n = 28) of mother–father–baby triads recruited through HELLP syndrome research websites. Cases were verified by medical chart abstraction when possible. Two SERPINA3 SNPs, rs4934 and rs1884082, were genotyped from saliva samples, mouthwash, or buccal swabs. The Haplin package in R was used to perform genetic association analyses. No evidence of increased risk related to individual SERPINA3 SNPs or haplotypes for the developing HDPs or sPE/HELLP was found in individual nor combined cohorts. In the HDP cohort, the g-a haplotype (relative to T-G haplotype) was borderline significant for increased risk of HDPs when carried by the child (double dose: RR = 1.58, 95% CI: (1.00, 2.52), p = 0.05). We observed significant parent-of-origin (PoO) effects in the combined cohort: specifically, an increased risk of HDPs/sPE/HELLP if the mother carries a double copy for both rs4934 (RR = 3.03, 95% CI (1.50, 6.09), p < 0.01) and rs1884082 (RR = 2.38, 95% CI (1.22, 4.71), p = 0.01). A reduced risk of HDPs/sPE/HELLP was observed for rs4934 (RR = 0.54, 95% CI (0.31, 0.98), p = 0.04) and rs1884082 (RR = 0.52, 95% CI (0.30, 0.91), p = 0.02) with child carriage of the maternally inherited allele. In contrast, child carriage of a paternally inherited copy of the variant allele for rs4934 increased risk of HDPs/sPE/HELLP (RR = 1.54, 95% CI (1.09, 2.20), p = 0.02). There was no evidence that SERPINA3 gene polymorphisms and haplotypes were associated with risk of HDPs or sPE/HELLP. However, significant PoO effects were observed in the combined cohort analysis, with child carriage of rs4934 that is maternally inherited decreasing HDPs/sPE/HELLP risk while a paternally inherited copy increases risk, suggesting a role for maternal–fetal genomic incompatibility. Full article

Early parent–child interactions are crucial for children’s social–emotional development. Mental state talk (MST)—language referring to thoughts, feelings, and intentions—is a key contributor. MST may be reduced in hearing parents of deaf or hard-of-hearing (DHH) children, who face unique communication challenges. Yet, existing research on MST in hearing parents of DHH children and on MST use by DHH children themselves is limited and fragmented, often focusing on MST quantity in a single context. Few studies have examined MST quality, variation across contexts, or its relationship with children’s social–emotional functioning. This study addresses these gaps by investigating MST quantity and quality across two activities and its associations with children’s MST and social–emotional development. Forty-eight hearing parent–DHH child dyads (ages 2–5) participated. MST was studied during storybook reading and free play. Children completed tasks on emotion understanding and theory of mind; parents reported on MS vocabulary and family characteristics. The results showed that parents adjusted MST complexity based on children’s age but not audiological characteristics. MST varied by activity, with different contexts eliciting distinct types of MST. Parental and child MST were associated, though not linked to children’s task performance. Findings highlight the importance of diverse interaction contexts and suggest a need for longitudinal research on MST’s developmental impact. Full article

Although widely used across disciplines, the terms emotion and feeling remain conceptually ambiguous, particularly within developmental science. Emotion is defined as an evolutionarily conserved, biologically embedded system of action readiness and intersubjective communication, shaped by attentional, neural, and physiological reactivity to environmental salience. In contrast, feeling is conceptualized as the consciously experienced, representational outcome of emotional activation, emerging through cognitive appraisal and symbolic processing. Building upon this distinction, the review explores how emotion develops within parent–child dyads through coregulated neurocognitive and psychophysiological mechanisms. Drawing on empirical evidence from eye-tracking studies of visual attention to emotional faces, functional near-infrared spectroscopy (fNIRS) research on social-emotional activation in prefrontal brain regions, and cortisol-based assessments of hormonal synchrony, the paper highlights how emotional attunement and transmission are embedded in early caregiving interactions. The review also emphasizes the moderating role of environmental sensitivity—both in children and parents—in shaping these developmental pathways. By positioning emotion as a dynamic, intersubjective process and feeling as its emergent experiential correlate, this review offers a novel developmental framework for understanding affect and proposes directions for future research on resilience, dysregulation, and intervention. Full article

Anxiety is a common negative emotional experience among preschoolers that can significantly affect their physical and mental health development. Investigating the key factors that influence preschoolers’ anxiety and the mechanisms by which they act is important. This study aimed to examine the relationship between family socioeconomic status and preschoolers’ anxiety and explore the mediating role of parenting style and preschoolers’ psychological resilience in this relationship. This study examined the relationship between family socioeconomic status and childhood anxiety from the perspective of family factors and personal psychological characteristics. The Family Background Questionnaire, the Parenting Styles and Dimensions Questionnaire, the DECA-P2, and the Preschool Anxiety Scale were distributed to 36,048 parent–child dyads (children aged 3–6 years) in China. The collected data were analyzed via SPSS 22.0 and Mplus 8.3. A set of serial mediation models was constructed to provide evidence supporting the role of the key factors of early childhood anxiety and their observed associations. There were two-way correlations between family socioeconomic status (SES), parenting style, psychological resilience, and anxiety level. SES demonstrated a significant negative association with preschoolers’ anxiety, with direct and indirect links between authoritative and authoritarian parenting styles and preschoolers’ psychological resilience. Specifically, SES was associated with lower anxiety in preschoolers through authoritative parenting styles and was linked to higher anxiety through authoritarian parenting styles. SES was also related to preschoolers’ anxiety through their psychological resilience. In summary, parenting style and children’s psychological resilience function as serial mediators in the relationship between SES and preschoolers’ anxiety. Family socioeconomic status significantly and negatively correlates with early childhood anxiety, and parenting style and preschoolers’ psychological resilience mediate this relationship, in this study conducted from the perspectives of both family factors and individual psychological traits of preschoolers. Full article

Background and Objectives: We examined how health-related quality of life (HRQoL) in children with congenital heart disease (CHD) and caregiver stress/burnout relate in terms of lesion severity. Methods: We enrolled 72 child–caregiver dyads at a tertiary centre (May 2023–April 2025). Children completed PedsQL and CDI (anxiety assessment via SCARED-C was descriptive and not modelled in APIM); caregivers completed SF-36, PSS-10, and the Parental Burnout Assessment (PBA). Lesion severity (mild n = 22, moderate n = 34, severe n = 16) and LVEF were abstracted. Pearson correlations and actor–partner interdependence models (APIM) estimated within- and cross-partner effects. Results: Child PedsQL decreased with severity (mild 81.2 ± 7.4; moderate 70.9 ± 8.1; severe 63.3 ± 5.1; p < 0.001); caregiver SF-36 Mental Component Summary (MCS) showed a parallel gradient (66.8 ± 9.2; 59.7 ± 8.5; 54.1 ± 7.9; p < 0.001). Child HRQoL correlated with caregiver MCS (r = 0.46) and inversely with caregiver stress (PSS r = −0.42) and burnout (PBA r = −0.39). In APIM, caregiver stress predicted a caregiver’s own MCS (actor β = −0.38, p < 0.001) and the child’s PedsQL (partner β = −0.26, p = 0.002); higher child depressive symptoms predicted lower caregiver MCS (partner β = −0.22, p = 0.006). Each step up in lesion severity independently reduced child PedsQL by 7.9 points and caregiver MCS by 5.3 points (both p < 0.001). Dyads with unscheduled hospitalizations (n = 43) had poorer scores in both members. Conclusions: Psychological wellbeing in CHD dyads is strongly interdependent; caregiver stress relates to lower child HRQoL and child mood to caregiver mental health. Brief dyadic screening (PedsQL/SF-36 with PSS/CDI) and integrated, family-focused interventions may better target high-risk families, particularly with severe lesions or recent hospitalizations. Full article