Conceptualizing the Role of Parent and Child Emotion Regulation in the Treatment of Early-Onset Behavior Disorders: Theory, Research, and Future Directions

Parent–child emotion dynamics in families presenting for behavioral parent training: Is there a link with child behavior, parenting, and treatment outcome?

“…In summary, ER has been identified as a potential mechanism in the treatment of many disorders. Yet, this study contributes to a literature that does not yet create a compelling case that ER is necessarily predictive of BPT outcomes, contrary to expectations (McKee et al, 2023). In part, this may be due to a literature largely informed by preliminary studies, including this one; at the same time, our findings indicate that the aspects of ER most relevant to BPT might not yet have been identified.…”

“…Behavioral parent training (BPT; also called parent management training, behavioral parenting interventions), a family of treatments with a common history, theory, and practice elements, is the standard of care early intervention for young children (3–8 years old) with BDs; yet not all families benefit equally (see Kaehler et al, 2016). In order to enhance the impact of BPT, it is important to examine key underlying mechanisms, including one promising candidate: emotion regulation (see McKee et al, 2023, for a review).…”

“…Emotion regulation (ER) is considered a broad multidimensional construct that includes intra- and interpersonal processes essential to initiating, maintaining, and shifting emotional responses (see Compas et al, 2017, for review). ER has been posited to underlie many psychological disorders throughout the lifespan, including data to show concurrent and prospective associations with externalizing difficulties in children (McKee et al, 2023). ER develops fairly early and at least initially primarily within the family context via processes such as observational learning (e.g., looking to the parent for clues for how to feel and behave), emotion-focused parenting practices (e.g., parent emotion coaching and responses to children’s emotions), and emotional climate (e.g., emotional expressivity; see Eisenberg et al, 1998; Morris et al, 2017; Paley & Hajal, 2022, for reviews).…”

“…In Morris et al’s (2017) Tripartite model for example, characteristics of the parent, such as their own emotional reactivity, and the child, such as vulnerability to having negative emotions, are posited to moderate the unfolding of these regulatory processes and in turn child development. Such processes are likely intensified in families of children with early onset BDs given their temperamental predisposition for emotional and behavioral dysregulation, as well as the coercive pattern (Patterson, 1982; also see Kaehler et al, 2016; McMahon & Forehand, 2003) of parent–child interactions posited to exacerbate and maintain associated behavioral challenges (McKee et al, 2023). In spite of such associations, standard BPT teaches parents skills to navigate their own and their child’s behavior, but not explicitly the emotions that may be linked to or underlie those behaviors.…”

“…Interest in ER as a potential mechanism and treatment target in BPT has thus continued to evolve, with enhanced versions of BPT emerging which include more explicit attention to ER and related skills. However, findings are mixed regarding whether such adaptations can improve typical outcomes of interest in BPT, parenting and child behavior (McKee et al, 2023). One possibility for this seeming inconsistency between rich theory and less compelling results is that we have not yet adequately assessed the most relevant aspects of ER: How emotional responses unfold during the parent–child interaction that are central to the BPT treatment context and how parents and children influence each other’s emotional responses during those interactions.…”