Parent-Child Memory Study: Improving Future Thinking Among Mothers

Study Overview
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Brief Summary
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Parents of children from impoverished communities are disproportionately more likely to engage in harsh physical discipline, which can lead to serious clinical outcomes, including suicidal ideation and attempts. One mechanism linking low resource environments and maladaptive parenting strategies is maternal delay discounting, or the tendency to value smaller, immediate rewards (such as stopping children's misbehavior via physical means) relative to larger, but delayed rewards (like improving the parent-child relationship). This study will examine the efficacy of implementing a low-cost, brief intervention targeting the reduction of maternal delay discounting to inform broader public health efforts aimed at improving adolescent mental health outcomes in traditionally underserved communities.

Detailed Description
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Harsh parenting is associated with serious and costly mental health problems among youth, including substance use, mood disorders, and suicidal ideation and behaviors. Of concern, these parenting practices are most common among families from impoverished communities; however, many behaviorally-based parenting interventions do not take into account the unique mechanisms linking environmental disadvantage to parenting approaches. While the causes of harsh parenting are complex and varied, one such mechanism may be parents' tendencies to prioritize immediate rewards (such as stopping a child's misbehavior via physical punishment like spanking and hitting) relative to larger, but delayed rewards (including improved parent-child relationship quality), known as delay discounting. The aims of the current study are to conduct a Stage 1 parent-child dyad randomized control trial (RCT) (n = 72) examining the effectiveness of a brief, episodic future thinking (EFT) intervention in a community setting serving low-income mothers and additional implementation data. Participants will be randomized to receive either Episodic Future Thinking (EFT) or Episodic Recent Thinking (ERT) intervention arms. This case series will examine the efficacy of episodic future thinking (EFT) compared to episodic recent thinking (ERT) to target reduction of parenting-related delay discounting. Outcomes will evaluate the effect of EFT on reducing maternal delay discounting and harsh parenting and improving child clinical outcomes.

Official Title
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Parent-Child Memory Study: Improving Future Thinking Among Mothers From a Traditionally Underserved Community to Reduce Harsh Parenting and Improve Child Outcomes - A Randomized Controlled Trial

Conditions
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Behavior, Health

Intervention / Treatment
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* Behavioral: Episodic Future Thinking (EFT)
* Behavioral: Episodic Recent Thinking (ERT)


Participation Criteria
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Eligibility Criteria
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Parent Inclusion Criteria: A mother and or grandmother from the Flint area with a child/grandchild between the ages of 5-10 who can provide legal consent for that child Self-report that they have consistent contact with the child/grandchild Willing to participate in the study Able to participate in written assessments and an intervention conducted in English Have a working cell phone that can receive and send text messages and be willing to receive/send text messages as part of the study Have a phone or device that's able to use video conferencing software if interested in virtual participation Parent Exclusion Criteria: Self-disclosed active suicidality/homicidality Self-disclosed current bipolar disorder, schizophrenia, or psychosis Self-reported current and ongoing involvement with child protective services Child Inclusion Criteria: Children must be between the ages of 5-10 and have a mother/grandmother willing to provide consent for their participation Willing to participate in parent-child observation sessions Elementary proficiency in English Willing to participate in study surveys Child Exclusion criteria: Self-disclosed active suicidality/homicidality Self-disclosed current bipolar disorder, schizophrenia, or psychosis

Ages Eligible for Study
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Minimum Age: 5 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Episodic Future Thinking (EFT)<br>Mothers will receive episodic future thinking (EFT). Mothers will meet with a peer mother who will administer the EFT intervention, including generation of several specific future events reflecting positive interactions with their child. The participant will be asked to discuss their relationship with their child and to give examples of both positive and negative parenting from their personal experience. The peer mother will then ask the participant to think about their long-term parenting goals and will discuss how to create a vivid event that will be easy to remember. We will also teach each parent a behavioral parent training element called Special Play Time. Following this session, participants are asked to engage in messaging that will prompt them to remember the specific future events they envisioned during their intervention session with the peer mother. | Behavioral: Episodic Future Thinking (EFT)<br>* The adapted episodic future thinking (EFT) intervention will focus on generation of vivid, substance-free, rewarding events that could happen in the future with their children.<br>|
| Active Comparator: Episodic Recent Thinking (ERT)<br>In the episodic recent thinking (ERT) condition, the participant will be asked to discuss their relationship with their child and to give examples of both positive and negative parenting from their personal experience. The peer mother will then ask the participant to think about the present and discuss how to focus on the present. Two positive recent events and two negative recent events will be used to create ERT scenes for the parent to envision their current relationship with their child. We will also teach each parent a behavioral parent training element called Special Play Time. Following this session, participants will receive messages over the course of two weeks including a reminder cue generated as part of the EFT and a prompt to remember these episodes in vivid detail. | Behavioral: Episodic Recent Thinking (ERT)<br>* In the episodic recent thinking (ERT) condition, the participant will instead describe in vivid details events that have occurred in the recent past.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Monetary Choice Questionnaire | The Monetary Choice Questionnaire (MCQ) is a 27-item binary-choice task, which asks participants to select between two hypothetical monetary amounts: a smaller reward available immediately (e.g. $49 today) or a larger reward available after a delay (e.g. $60 in 89 days). The measure is scored to derive a discounting rate k, with larger values reflecting more problematic rates of discounting. Because k distributions are typically skewed, post-hoc natural logarithmic transformations will be performed, which have been shown to approximate normal distributions. The MCQ has been shown to have strong psychometric properties among adults and correlates with real rewards, as well as real-world risk behaviors. | Baseline, Intervention, Week 2, Month 3, Month 6, Month 9 | 
| Change in Consideration of Future Consequences Scale Score | The Consideration of Future Consequences Scale1 (CFCS-14) is a 14-item self-report questionnaire that assesses active consideration of longer-term implications of an individual's actions. Lower scores on the CFCS-14 are associated with a greater focus on immediate needs and have been found to be associated with less engagement in health behaviors1819 and greater substance use. The measure has been used extensively among adult samples and demonstrates strong reliability and validity. Research suggests modest but significant correlations with the MCQ. Change in CFCS-14 score is measured by comparing scores at the post-intervention assessment timepoints with baseline scores. | Baseline, Intervention, Week 2, Month 3, Month 6, Month 9 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Alabama Parenting Questionnaire Score | Parents and their children will complete a 20-minute interaction task, including five minutes of free play, a ten minute homework task in which children are given a math worksheet and parents are told to provide help as you see fit, and a five minute clean up task. Interactions will be video recorded and coded using the Dyadic Parent-Child Interaction Coding System (DPICS) which yields to composite scores: positive parenting (including praise, positive affect, and physical positive interactions) and negative parenting (including negative commands, critical statements, and physical negative interactions). Change in positive parenting and negative parenting scores will be calculated by comparing baseline scores with scores at the post-intervention timepoints. | Baseline, Intervention, Week 2, Month 3, Month 6, Month 9 | 
| Change in Emotion Regulation Checklist | Parents will report on children's emotion regulation using the Emotion Regulation Checklist (ECR). The ECR includes 24 items that yield two subscales: (1) lability/negativity and (2) emotion regulation. The measure is widely used and validated for parent-report of older children and young adolescents. | Baseline, Intervention, Week 2, Month 3, Month 6, Month 9 | 
| Change in How I Feel (HIF) | The HIF can be useful in understanding the interplay between arousal and control in social-emotional adjustment in school-age children. The HIF samples positive and negative emotions from the domain of basic emotions. It provides a self-report of children's general positive and negative emotional arousal. | Baseline, Week 2 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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episodic future thinking, episodic recent thinking, delay discounting, parent-child relations, low resource, Flint, Michigan, special play time