Early parent-child interactions, namely how parents respond to their children's emotions (i.e., emotion socialization parenting practices \[ESPP\]), may play a critical role in how children develop emotion regulation abilities. When parents rely on unsupportive ESPP, this can result in regulatory problems, which are a transdiagnostic symptom of MH problems, being a major cause of its etiology. Emotion-focused parenting programs, such as Tuning in to Kids® (TIK), promote parents' emotion coaching skills, enabling children to understand and regulate their emotions in more effective ways, while also supporting parents in managing their own emotions. This study aims to examine the feasibility, acceptability, implementation fidelity and efficacy of the TIK program among parents of preschool-aged children in Portugal. TIK is a 6-week group, face-to-face program grounded in the principles of emotion coaching, among other theoretical backgrounds such as Mindfulness and Emotion Regulation Theories. This trial is a parallel two-arm randomized clinical trial. Participants will be parents/legal guardians (\> 18 years old) with at least one child between 3 and 6 years old and with proficiency in portuguese. At least 152 parents/legal guardians will be recruited with the support of several community partners. Interested parents will be contacted by telephone to confirm their eligibility. Participants will be informed about their eligibility during the intake interview, followed by a full explanation of the clinical trial procedures. Eligible participants will be randomly assigned to either the intervention group (TIK) or a waitlist control group, with the latter receiving the intervention after the follow-up assessment. The intervention consists of six weekly in-person group sessions plus one follow-up session, each lasting approximately 2 hours. Participants in both groups will complete questionnaires at three time points - baseline, post-intervention, and 2-month follow-up - covering different dimensions of children (e.g., children's emotional and developmental difficulties) and parental (e.g., parenting stress) psychological functioning, and parenting (e.g., ESPP).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
152
Tuning in to Kids® (TIK) is a manualized program delivered by trained facilitators (6 weekly - 2h - group sessions) and aimed to promote parents' emotion socialization practices that are supportive of the child's expression of emotion (emotion coaching; e.g., comforting, teaching constructive means of coping), while reducing unsupportive ESPP (emotion dismissing; e.g., punishing or minimizing). An additional booster session may be held after two months of program's conclusion. TIK includes strategies informed by emotion coaching principles, including psychoeducation, roleplays, video materials, mindfulness-based exercises, and group discussions. By addressing a core mechanism leading to different emotional and behavioral childhood disorders (i.e. difficulties in emotion regulation), TIK is susceptible to promoting children's long-term full potential and parental mental health outcomes.
School of Psychology and Life Sciences, Lusófona University
Lisbon, Portugal
RECRUITINGChanges from baseline in parents' beliefs about children's emotions
Measured with the Parents' Beliefs About Children's Emotions Questionnaire (PBACE). The PBACE is a 33-item self-report questionnaire, with items rated on a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). The present study will use the following subscales: Value of Anger, Manipulation, Control, and Autonomy. Subscale scores will be calculated by averaging item responses, with higher scores indicating stronger endorsement of the corresponding belief in that category.
Time frame: Baseline, immediately post-intervention, and 2 months follow-up
Changes from baseline in parents' reactions to children's emotions
Measured with the Coping with Children's Negative Emotions Scale (CCNES). The CCNES is a parent-report measure assessing how parents respond to children's negative emotions across 12 hypothetical scenarios, with responses rated on a 7-point Likert scale from 1 (very unlikely) to 7 (very likely). The CCNES comprises seven subscales: Emotion-Focused, Problem-Focused, Expressive Encouragement, Minimizing, Punitive, Distress, and Ignoring reactions. Items from the first three subscales are summed to create a composite measure of emotion coaching, whereas items from the remaining four subscales are summed to assess emotion dismissing responses. For each scale, total scores are calculated by averaging item responses, with higher scores indicating greater endorsement of the corresponding practice.
Time frame: Baseline, immediately post-intervention, and 2 months follow-up
Changes from baseline in parents' emotion regulation (parenting-specific)
Measured with the Interpersonal Mindfulness in Parenting Scale (IM-P). The IM-P is a 29-item self-report instrument rated on a 5-point Likert scale, from 1 (never true) to 5 (always true). The Self-Regulation in Parenting will be assessed as primary outcome. Subscale scores will be calculated by summing item responses. Higher scores on the Self-Regulation in Parenting subscale indicate greater ability to regulate emotions and behaviors within the parenting context.
Time frame: Baseline, immediately post-intervention, and 2 months follow-up
Changes from baseline in parents' emotional regulation (general)
Measured with the Difficulties in Emotion Regulation Scale - Short Form (DERS-SF). The DERS-SF is a self-report measure, including 18 items, rated on a 5-point Likert scale, ranging from 1 (almost never) to 5 (almost always). A total score is obtained by averaging all items, with higher scores indicating greater difficulties. In line with the recommendations of the Portuguese authors, items 1, 4 and 6 will be excluded from the analyses.
Time frame: Baseline, immediately post-intervention, and 2 month follow-up
Changes from baseline in children's behavioral and emotional difficulties
Measured with the Strengths and Difficulties Questionnaire - Parent (SDQ-P). The SDQ-P is a self-report measure for parents, including 25 items, each rated on a 3-point Likert scale, from 0 (not true) to 2 (certainly true). The total difficulties score is calculated by summing the scores from the following subscales: Emotional Symptoms, Conduct Problems, Hyperactivity/Inattention, and Peer Relationship Problems. Higher scores reflect greater difficulties. The Prosocial Behavior subscale is scored separately, as a measure of strengths. Two age-specific versions will be presented to parents (for children aged 3-4 and 5-6). The versions differ slightly in wording, but share the same scoring method and interpretation.
Time frame: Baseline, immediately post-intervention, and 2 month follow-up
Changes from baseline in children' emotional regulation
Measured with the Emotion Regulation Checklist (ERC). The ERC is a self-report measure consisting of 20 items rated on a 4-point Likert scale, ranging from 1 (never) to 4 (almost always). The ERC comprises two subscales: Emotion Regulation, and Emotion Lability/Negativity. For each subscale, a total score is obtained by the sum of the items. Higher scores on the Emotion Regulation subscale indicate higher emotion regulation; whereas higher scores on the Lability/Negativity subscale indicate higher difficulties in emotion regulation.
Time frame: Baseline, immediately post-intervention, and 2 month follow-up
Changes from baseline in parenting stress
Measured with the Parental Stress Scale (PSS). The PSS is a self-report scale comprising 18 items rated on a 5-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree). A total score is calculated by summing all items, with higher scores reflecting higher levels of parenting stress. Following the recommendations from the Portuguese authors, items 1-2 and 17-18 will be excluded from the analyses.
Time frame: Baseline, immediately post-intervention, and 2 month follow-up
Changes from baseline in depressive symptoms
Measured with the Depressive Symptoms subscale of the Hospital Anxiety and Depression Scale (HADS). This subscale consists of 7 items rated on a 4-point Likert scale, from 0 to 3 (e.g., "not at all", "most of the time"). The total score is obtained by summing the scores of the items, with higher scores being indicative of higher levels of depressive symptoms.
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Time frame: Baseline, immediately post-intervention, and 2 month follow-up
Changes from baseline in parenting self-efficacy
Measured with the Self-Efficacy subscale of the Me as a Parent Questionnaire (MaaP). This subscale consists of 4 items rated on a 5-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree). A total score is obtained by adding up the items, with higher scores reflecting higher levels of perceived self-efficacy.
Time frame: Baseline, immediately post-intervention, and 2 month follow-up