Faculty Bibliography

To synthesize current knowledge of the impact of pediatric neuropsychological evaluations on child functioning, we conducted a systematic review of the literature on parents' overall satisfaction with their child's evaluation and perceptions of how helpful the evaluation was for understanding their child's abilities and how useful the evaluation was for providing actionable information to elicit change. Parent satisfaction is important in this context because studies on healthcare consumption indicate a substantial relationship between patient satisfaction with services and implementation of recommendations and follow-up care. We followed PRISMA guidelines to conduct a systematic review of the literature on parent perception of pediatric neuropsychological evaluations for children aged 3-21 years. Using a set of predefined search terms, we identified 1,163 abstracts across PubMed, PsycINFO, Cochrane Library, and Web of Science electronic databases and included 12 studies in our qualitative synthesis. In general, parents reported high levels of satisfaction with their child's evaluation. Feedback from the evaluation was helpful for understanding their child's pattern of strengths and weaknesses and included useful information for obtaining support. Although parents did report improvement in their child's functional participation in home, school, and community settings, they tended to rate the usefulness of the evaluation for eliciting change lower than their overall satisfaction with the evaluation or how helpful the evaluation was for understanding their child's abilities. Additional effort appears to be needed for pediatric neuropsychological evaluations recommendations to result in durable, meaningful change in child functioning.

Although literature supports the association between harmonious coparenting practices and lowered child problems, little is known about coparenting influences among family constellations in the foster care system. Via a compilation of a new coparenting practices measure, we examined similarities and differences on foster parent-derived perceptions of support/flexibility, shared communication, conflict/triangulation, and total coparenting between foster and biological parents and their independent contribution to child internalizing and externalizing problems. Self-reports were gathered from foster parents (N=80) in 2 groups: kin and nonkin. As compared with nonkin, kin foster parents reported higher perceived support/flexibility, shared communication, and total coparenting. A tendency for higher conflict/triangulation among kin foster parents was also found. After considering foster parent group, psychological distress, and harsh discipline, hierarchical regression analyses revealed that perceived total coparenting and conflict/triangulation contributed to child internalizing and externalizing problems. Results support the linkage between perceptions of coparenting and child problems among caregivers (foster and biological alike) in kin and nonkin arrangements and highlight training in coparenting in general, and conflict management in particular, as an important intervention focus to reduce the high level of child problems in this vulnerable population.

In a sample of 124 parents (62 pairs of biological and foster parents) of children who were maltreated (M age = 6.2 years), this study compared self-reports of discipline practices between biological and foster parents toward a target child and explored the role of child, parent, and foster care ecology factors on discipline practices. Controlling for parental age, psychological distress, and marital status, biological and foster parents reported using similar levels of positive, appropriate, and harsh discipline. For biological and foster parents, child characteristics (being female, younger, and having more conduct problems) were associated with parental self-reports of less effective discipline. The study also found a positive association between parent-to-parent cooperation and effective discipline. These findings suggest that parenting interventions may need to move beyond simple presumption of deficits in parenting knowledge, and that children could benefit from enhancement of supportive relationships between biological and foster parents involved in the foster care system

The purpose of this study was to evaluate the effectiveness of a 2-component intervention for biological and foster parent (pairs) to improve parenting practices, co-parenting, and child externalizing problems. Participants were biological and foster parents (N=128) of primarily neglected children (ages 3 to 10 years) placed in regular foster homes. Biological and foster parents were randomly assigned in pairs to the intervention (n=80) or a usual care (n=48) condition. Intervention families received a 12-week parenting course (Incredible Years) and a newly developed co-parenting component. Key findings included significant gains in positive parenting and collaborative co-parenting for both biological and foster parents at the end of the intervention. At follow-up, intervention parents sustained greater improvement in positive parenting, showed gains in clear expectations, and reported a trend for fewer child externalizing problems. Findings supported the feasibility of offering joint parenting training to meet the needs of participating families and demonstrated that the co-parenting construct applied to families in the foster care system was amenable to intervention

Increasing evidence suggests that 'co-parenting', the extent to which parents function as partners or adversaries in their parenting roles, makes an independent contribution to child adjustment, beyond the influence of parenting alone (Cowan & McHale, 1996). This study is the first of its kind to extend the investigation of co-parenting to foster-care. Two measures of co-parenting in foster care were developed, a coding scheme for observations (Foster Care & Co-parenting Rating System; FCCRS) and a questionnaire (Co-parenting Events Scale; CES), to study the impact of co-parenting in foster care on behavior outcomes. Participants were 24 biological and foster parents and their 3 to 10 year old foster child (M = 6.9 years: SD = 2.6). Most families (over 90%) fell below the midpoint on the FCCRS supportive (M = 9.2, SD = 2.1) and unsupportive subscales (M = 6.6, SD = 1.5). Although a strong relationship was not found between FCCRS scales and child behavior, medium to large relationships were found for the CES. A significant large inverse effect was found for biological parents on CES and externalizing behavior problems, r = -.89, p = 02; large negative effects were also found for internalizing and total behavior problems, although not significant, r = -.59, p = .22 and r = -.69, p = .13, respectively. For foster parents, only a large negative effect was found between CES and internalizing behavior problems, r = -.68, p = .14. Social competence was only positively related to FCCRS supportive co-parenting, r = .40, p = .05, and inversely related to FCCRS unsupportive co-parenting, r = -.25, p = .25. Findings on the CES, though, should be interpreted with caution (n = 6) and need replication. Co-parenting patterns were subsequently more fully examined through exploratory analyses. Findings support the application of two new co-parenting measures in foster care and underscore the need for further research into the relationships between biological and foster families and child outcomes. The unique focus on the co-parenting relationship in foster care underscores important targets for intervention and prevention and emphasizes the need for services that are multimodal and designed to address child, family (foster and biological) and social factors.

The purpose of this study was to determine whether asthma status and severity have an impact on the quality of life of urban elementary school children. Participants were 1292 caregiver-child dyads from six schools serving low-income, ethnic minority, urban families; 53% of the children were female. Caregivers provided data on the children's asthma diagnosis and frequency in the last 12 months of asthma symptoms, use of medication for asthma, emergency room visits, and hospitalizations. Using the KINDL, a generic quality of life instrument, children reported on their health-related quality of life (HRQL). Results revealed a high prevalence of current asthma (18%). No differences were found in HRQL based on having current asthma or the severity of asthma as assessed by proxy measures of health care utilization and limited functioning. These findings are consistent with previous research indicating that HRQL is influenced by several factors other than asthma status and severity. The implications of these results for intervention are discussed