Kimberly Renk

Background/Objectives: The opioid epidemic and adverse childhood experiences (ACEs) are two major concerns for child welfare systems. Little is known, however, regarding the mechanisms that perpetuate intergenerational cycles of ACEs and insecure/disorganized parent–young child attachment patterns in the context of parents’ opioid use. Methods: A high-risk sample of 101 parents (75 mothers and 26 fathers) who were opioid-involved, who had a child in the 0- to 5-year age range, and who were receiving medication-assisted treatment in the United States of America participated in this study. Parents were mostly White/Caucasian and single. Direct pathways between parents’ reported ACEs and their perceived parent–young child attachment patterns, as well as indirect pathways through substance use severity, depression, and trauma symptoms, were examined. Results: PROCESS analyses suggested that mothers’ ACEs significantly predicted their ratings of disorganized attachment patterns with their young children, with depression and trauma symptoms explaining greater variance than ACEs alone. The results indicated that fathers’ ACEs were not predictive of insecure/disorganized attachment patterns with their young children. Substance use severity was not predictive of parent–child attachment patterns for mothers or fathers. Conclusions: Generally, these findings highlighted different patterns among mothers and fathers’ ACEs, their ratings of parent–young child insecure/disorganized attachment, and their psychological sequelae. These findings further suggested the utility of trauma- and attachment-informed parenting interventions for high-risk mothers and fathers in breaking intergenerational cycles of risk.

Although professionals who work with children and adolescents are well aware of psychological symptom presentations once children and adolescents are in school, such symptom presentations in very young children are less understood. Diagnoses like selective mutism may promote further complications for professionals, as the symptom presentation of anxiety and failure to speak in this diagnosis may overlap with the acquisition of speech and language milestones and problems in very young children. Thus, providing professionals who work with very young children a way to adapt their thinking about selective mutism symptom presentations and interventions is of utmost importance. As a result, this clinically oriented paper will compare DSM-5-TR criteria to DC:0-5 criteria, consider the occurrence of selective mutism symptoms in the context of young children’s speech and language milestones and problems, and reflect upon how intervention adaptations meant to incorporate parents into treatment and account for the capacities of very young children can be helpful in facilitating successful outcomes. It is hoped that having this constellation of clinical information in one place will help providers gain clarity regarding selective mutism symptom presentation and relevant intervention considerations for very young children.

Discussions centering around “the” optimal parenting style have been occurring since researchers have had interest in parent-child interactions. Similarly, the effects of parenting stress on children’s development have been researched widely. The relationships among parenting styles, parenting stress, and parents’ perceptions of their young children’s competencies have not received significant attention, however. As such, this study sought to understand these relationships in a sample of mothers and fathers with young children. This study collected self-report data from 84 mothers and 43 fathers regarding their parenting styles, parenting stress, and ratings of competencies displayed by their young children. Correlational and mediation regression analyses suggested that, for mothers’ reports, an authoritative parenting style was correlated negatively with parenting stress and parenting stress was correlated negatively with peer acceptance. Further, the findings of this study showed that the relationship between authoritative parenting styles and peer acceptance was mediated fully by parenting stress for mothers’ reports. Such mediational findings were not replicated for fathers’ reports. These results suggested the importance of parenting styles and parenting stress for young children’s development of competencies, especially from mothers’ perspective.

It is understood that childhood exposure to intimate partner violence (IPV) can contribute directly and indirectly to adult outcomes, including parenting behaviors. To further understand these associations, this study examined the relationship between mothers’ childhood exposure to IPV and their parenting behaviors while using adult IPV as a moderator. The study included a sample of 133 mothers with children who could range in age from 1½- to 5-years. Mothers provided ratings of their childhood exposure to IPV, their adult IPV experiences, and their parenting behaviors. Findings suggested that mothers’ adult IPV experiences moderated significantly the relationship between mothers’ exposure to childhood IPV and their parenting behaviors (i.e., positive parenting, negative/inconsistent parenting, and punitive parenting). These findings suggested that mothers’ childhood exposure to IPV was related to how they parent their young children in the context of mothers’ IPV experiences in their adult relationships. These findings further suggested the importance of preventing children’s exposure to IPV, identifying interventions for mothers who were exposed to IPV in their childhood as well as in their adult relationships, and providing appropriate parenting interventions for these mothers. Such multi-targeted approaches will aid in potentially reducing the rates of intergenerational IPV in families.

Given that young children of mothers with adverse childhood experiences (ACEs) exhibit increased risk for maladaptive outcomes (including being maltreated by their caregivers), this study investigated a comprehensive model for predicting children’s emotional and behavioral problems in the context of mothers’ ACEs. A community sample of 146 mothers with children aged one and onehalf to five years provided ratings of their ACEs, depressive symptoms, parenting characteristics, mother–young child attachment, and young children’s internalizing and externalizing problems. Mothers’ ACEs and depressive symptoms predicted uniquely young children’s internalizing problems. In contrast, mothers’ ACEs, depressive symptoms, and punitive parenting behaviors predicted uniquely young children’s externalizing problems. These results suggested the importance of trauma-informed interventions for high-risk mothers who may be involved with child welfare systems and for their young children who are likely to exhibit emotional and behavioral problems as child custody decisions are made.

This case study followed a 4-year-old Caucasian female in cancer remission who presented with symptoms of posttraumatic stress disorder (PTSD). Given the age of this young girl and the health difficulties that she experienced, the preschool PTSD treatment (PPT) manual was implemented to address her distressing symptoms. In addition, it was important to include this young girl’s primary caregiver at each step of the treatment process. Following treatment, this young girl demonstrated significant improvement in her symptomology, as measured quantitatively and qualitatively. Further, this young girl was able to utilize the skills and techniques that she learned and generalize them to other circumstances that caused discomfort or emotional difficulty for her. This case study also demonstrated that incorporating intensive parental involvement with PPT can further the reduction of PTSD symptoms in young children who have experienced medically related trauma.

This case study outlines the treatment of a 5-year-old Caucasian male who presented with symptoms of selective mutism (SM) along with significant impairment related to comorbid anxiety and speech difficulties. To address these symptoms, Integrated Behavior Therapy for Selective Mutism (IBTSM) was utilized for the treatment of this young boy’s SM and comorbid anxiety. An attachment focus was incorporated as a framework for conceptualizing his SM symptoms. As the treatment of this young boy’s symptoms proceeded, it became clear that his underlying speech difficulties needed to be addressed as well, as these difficulties were preventing expected progress to occur. Thus, this young boy’s treatment was individualized to fit his unique difficulties. In shifting the treatment focus to “being brave like a superhero,” significant decreases were achieved in this young boy’s overall internalizing and Diagnostic and Statistical Manual of Mental Disorders (DSM)-related anxiety symptoms, facilitating a successful transition to speech and language therapy. This case study is distinctive in its description of the complexities that may come along with treating symptoms that appear consistent with SM along with other comorbid conditions and nuanced circumstances.

Although research has suggested that mothers who experienced childhood maltreatment tend to exhibit heightened risk for attachment difficulties with their young children, less is known about the mechanisms underlying this association. Thus, this study examined mothers’ symptoms of depression as a mediator in the relationship between mothers’ childhood maltreatment experiences and patterns of insecure (i.e., anxious, avoidant, and disorganized) mother–young child attachment. Mothers (N = 146) with children aged 1½-to 5-years provided ratings of their childhood maltreatment experiences, attachment with their young children, and symptoms of depression. Mothers’ symptoms of depression mediated significantly the relationship between mothers’ childhood maltreatment experiences and patterns of insecure mother–young child attachment. These findings suggested that symptoms of depression in the context of mothers’ childhood maltreatment may be related more directly to mother–young child attachment than childhood maltreatment experiences alone. These results demonstrated the importance of promoting trauma-informed parenting interventions for facilitating secure emotional connections between mothers and their young children.

This case study follows a 7-year-old boy who presented with symptoms of posttraumatic stress disorder (PTSD) following exposure to domestic violence beginning at a very young age. During evaluation of this young boy’s symptoms, it became evident that his mother also was experiencing symptoms of PTSD. Consequently, treatment for both this young boy and his mother was proposed. Cognitive-behavioral therapy (CBT) has been used widely with both children and adults to treat PTSD. Fortunately, treatments have been tailored for young children (e.g., trauma-focused CBT [TF-CBT]; preschool PTSD treatment [PPT]) and for adults (e.g., cognitive processing therapy [CPT]). In the current case study, a combination of PPT and TF-CBT was utilized to treat this young boy, and CPT was utilized to treat his mother. With this course of treatment, this young boy demonstrated decreases in his PTSD symptoms and gained an understanding of coping skills and cognitive restructuring. His mother also demonstrated decreases in her PTSD symptoms. Overall, this dyad showed qualitative improvements in their general emotional and behavioral functioning, their individual self-regulation abilities, their social interactions, and their relationship. This case study provides evidence for the importance of treating both young child and parent when both have been exposed to and traumatized by domestic violence. Furthermore, this case study provides a framework for other health service providers to implement conjoint treatment of similarly traumatized families.