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Early Emotion Development Intervention Improves Mental Health Outcomes in Low-Income, High-Risk Community Children

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Abstract

Children living in poverty and facing related forms of adversity are at higher risk for experiencing concurrent and later psychopathology. Although negative psychological outcomes can be improved by enhancing sensitive and responsive caregiving early in development, interventions targeting the caregiver–child dyad are not readily accessible. The present study investigated the feasibility and effectiveness of delivering a shortened eight-session form of Parent–Child Interaction Therapy-Emotion Development (PCIT-ED) in-person or remotely as an early intervention for 3–6-year-old children (N = 62) at elevated risk for psychopathology who were growing up in low-income communities. Caregiver–child dyads were randomized to eight-sessions of PCIT-ED or online parenting education. Relative to parenting education, children receiving PCIT-ED exhibited lower externalizing symptoms and functional impairment and more positive peer relationships following the intervention. Findings support the effectiveness of this shortened form of PCIT-ED, delivered in-person or remotely, as an early intervention to improve symptoms of psychopathology and functioning in high-risk children living in poverty.

Trial registration Clinicaltrials.gov; NCT04399629.

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Data Availability

Data and materials are available upon request.

Notes

  1. The intervention was initially adapted to be administered over 12-sessions; however, it was further reduced to eight-sessions early in the study after it became apparent that 12 sessions posed a substantial burden to participants. Tables S1–2 provide detailed information about the number of sessions completed by each participant. Post-hoc analyses examining (1) number of sessions as a continuous variable, and (2) comparing participants who completed 3–8 sessions with those who completed nine or more sessions, indicated that the number of sessions completed was not significantly associated with externalizing or internalizing symptoms at the post-intervention assessment.

  2. A subset of participants also completed a baseline and post-assessment observed parenting task (n = 27), an electroencephalogram (EEG; n = 4),and/or functional near infrared spectroscopy (fNIRS; n = 6) sessions. The COVID-19 stay home orders substantially affected our ability to collect this data remotely and in a timely manner. Given methodological differences and smaller sample sizes, these exploratory data will be reported elsewhere.

  3. A parallel intent-to-treat analysis was also conducted that limited the sample to the first sibling enrolled from each pair. Findings pertaining to externalizing symptoms, global peer relations, and parental optimism remained significant (ps < .05), indicating potential dependency from sibling pairs in the data is not driving these findings. Trend-level significance was observed for internalizing symptoms (p = 0.052), but not for functional impairment-family (p = 0.068) and social withdrawal (p = .112; Supplement 3, Table S3).

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Funding

Funding for this research was provided by the Washington University Office of the Chancellor and Provost, St. Louis Children’s Hospital, the Jennings School District, and Head Start/Early Head Start at the Urban League of Metropolitan Saint Louis. This research was also supported by the National Institute of Mental Health (K01 MH127412 to LH; K23 MH115074 to KG; K23 MH125023 to MRD).

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Authors and Affiliations

  1. Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA

    Laura Hennefield, Kirsten Gilbert, Meghan Rose Donohue, Rebecca Tillman, Patricia L. Kohl & Joan L. Luby

  2. Saint Louis University, The Jennings School District, Jennings, MO, USA

    Art McCoy

  3. Head Start/Early Head Start at the Urban League of Metropolitan, Saint Louis, MO, USA

    Gwendolyn Diggs

  4. Department of Counselor Education and Counseling Psychology, College of Education, Marquette University, Milwaukee, WI, USA

    Zori A. Paul

  5. The Brown School of Social Work, Washington University in Saint Louis, Saint Louis, MO, USA

    Patricia L. Kohl

  6. Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park, Suite 2100, Saint Louis, MO, USA

    Laura Hennefield

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  1. Laura Hennefield
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JLL, ZAP, and RT. The first draft of the manuscript was written by LH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Laura Hennefield.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by Washington University’s Institutional Review Board, #201907157.

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Hennefield, L., Gilbert, K., Donohue, M.R. et al. Early Emotion Development Intervention Improves Mental Health Outcomes in Low-Income, High-Risk Community Children. Child Psychiatry Hum Dev (2024). https://doi.org/10.1007/s10578-023-01639-1

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