Caregiver Mental Health and Child Functioning During Early Childhood: The Moderating Roles of Caregiver-Child Relational and Engagement Factors

Open Access
- Author:
- Chimed-Ochir, Ulziimaa
- Graduate Program:
- Human Development and Family Studies
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- July 02, 2024
- Committee Members:
- Douglas Teti, Program Head/Chair
Douglas Teti, Chair & Dissertation Advisor
Steffany Fredman, Major Field Member
Rina Eiden, Outside Unit & Field Member
Christian Connell, Major Field Member - Keywords:
- Maternal Depressive Symptoms
Infant-mother attachment security
Infant behavioral problems
Caregiver trauma symptoms
Attachment Regulation and Competency Treatment
Child trauma symptoms - Abstract:
- Fostering children’s mental well-being and socio-emotional development during early childhood is imperative, given the heightened malleability of this period and the potential for long-term health benefits through timely interventions. The healthy development of young children depends significantly on their parents' mental well-being and their capacity to cultivate quality relationships with their offspring. Using multilevel modeling (MLM), this study explored how caregiver mental health issues interact with the quality of child-caregiver relationships and levels of engagement to predict child behavioral and mental health outcomes during early childhood (ages 1-6 years). Study I investigated how infant-mother attachment security moderates the relationship between maternal depressive symptoms and infants' problem behaviors, encompassing externalizing, internalizing, and dysregulation, across the second year of life. The data were drawn from 123 mothers with healthy, full-term infants (50.4% girls) participating in a longitudinal NIH-funded project. At 12, 18, and 24 months of age, maternal depressive symptoms were self-reported using a subscale of the Symptom Checklist-90-Revised. Trained observers assessed infant-mother attachment security during home visits at each time point using the Attachment Q-Set. Behavioral problems were reported by mothers using the Infant-Toddler Social and Emotional Assessment. The results provided strong evidence for the harmful impact of maternal depressive symptoms (MDS) on all infant behavioral problems across the second year. Additionally, attachment security had a significant effect on changes in externalizing problem behaviors during this period. Specifically, at the between-person level, infants with higher average attachment security exhibited lower levels of externalizing behaviors at 18 and 24 months compared to those with lower average attachment security, though this difference was not observed at 12 months. Importantly, at the within-person level, attachment security offered protection against the effects of maternal depressive symptoms at 12 months, but this protective effect was not evident at 18 or 24 months. Study II examined changes in children’s trauma symptoms during the Attachment, Regulation, and Competency (ARC) treatment and whether the change was predicted by direct and interactive effects of caregiver trauma symptoms and the dosage of caregiver-child conjoint participation over nine months post-intake. One hundred ninety-one caregiver-child (63.4% birth/adoptive mother, M age = 5.39 years, SD = 1.02, 43.5% girls) dyads received ARC treatment. Caregiver and child symptoms were measured using caregiver-reported Young Child PTSD Checklist and PTSD Checklist for DSM-5 at baseline and quarterly during the 9-month observation period. Clinicians reported the dosage of treatment that dyads received on a monthly basis. The results revealed that children experienced declining levels of trauma symptoms over time while engaged in ARC services. Furthermore, the results revealed a positive association between caregiver trauma symptoms and child trauma symptoms at both between- and within-person levels. Importantly, this association was not significant at the within-person level for dyads receiving a higher number of conjoint sessions but was strong for those receiving fewer conjoint sessions. Additionally, at the between-person level, child symptoms generally improved for children whose caregivers were experiencing lower levels of symptoms, regardless of the frequency of conjoint sessions. A similar effect was observed among children with caregivers experiencing higher levels of symptoms, but only when dyads engaged in a greater frequency of conjoint sessions. Overall, this dissertation emphasized the complex interplay between caregiver mental health, indicators of caregiver-child relationship and engagement, and child functioning. The findings underscored that high-quality caregiver-child relationship and frequent engagement act as protective factors against caregiver mental health problems during early childhood.