In this Papers Podcast, Dr. Tone Hermansen discusses her JCPP Advances paper ‘Child internalizing and externalizing behaviors: Interplay between maternal depressive symptoms and child inhibitory control’ (https://doi.org/10.1002/jcv2.12107).
There is an overview of the paper, methodology, key findings, and implications for practice.
Discussion points include:
- How low levels of inhibitory control present in children.
- Why children with lower levels of inhibitory control are particularly vulnerable to negative environmental influences.
- Are children with higher levels of inhibitory control more likely to internalise rather than externalise problems?
- How the findings may be translated into practice, in terms of the development of treatment options and interventions.
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
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Dr. Tone Hermansen is a postdoctoral research fellow at the Department of Psychology, University of Oslo. Her research combines developmental and educational psychology to identify mechanisms of children’s cognitive development and social learning–primarily through designing and conducting experiments. After completing her PhD in Psychology at the University of Oslo, she has pursued this interest through multiple research projects and during her time as a Fulbright scholar at Harvard University.
[00:00:01.430] Jo Carlowe: Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. In this series, we speak to authors of papers published in one of ACAM’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances.
Today, I’m interviewing Dr. Tone Hermansen, Post-Doctoral Fellow at the Department of Psychology at the University of Oslo and the first author of the paper, “Child Internalising and Externalising Behaviours: Interplay Between Maternal Depressive Symptoms and Child Inhibitory Control,” recently published in JCPP Advances. Tone’s paper will be the focus of today’s podcast.
If you’re a fan of our Papers Podcast series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues.
Tone, welcome, thank you for joining me. Can you start with an introduction about who you are and what you do?
[00:01:15.150] Dr. Tone Hermansen: Yeah. Hi, and thank you for having me. Always good to get a new chance to talk about your papers, particularly in a one-to-one, when we so often present in conferences. As you say, I’m a Post-Doctoral Fellow in University of Oslo, Norway. The overarching theme for a lot of my work is to look at how individual and contextual factors interplay during development and lead to the persons that we are. And so, what this paper reflects is how we looked at this in a family environment that operates slightly less typical because there is a mental health issue during the child’s early years.
[00:01:51.579] Jo Carlowe: So, as I described in the intro, we’re going to look at your paper. This is “Child Internalising and Externalising Behaviours: Interplay Between Maternal Depressive Symptoms and Child Inhibitory Control,” which was recently published in JCPP Advances. Before we go into the details, can you give a quick definition of inhibitory control and how low levels of this present in children?
[00:02:14.700] Dr. Tone Hermansen: So, that’s an important thing to get an understanding of when we dig into this paper, and I think the general way to think about inhibitory control is that it’s an ability to withhold something, to control something, and it can be your thoughts, but it can also be your emotions and your behaviour. So, as an example, it can be that when you have experienced something and you remember that event, and that event keeps going through your mind constantly. It ends up being almost a rumination and if you’re good at inhibiting your thoughts, you can stop this rumination and end that thought process and move onto the – to what the day is about.
And similar for emotions and behaviours, that some things are adequate responses and sometimes we should think about things twice, or we can act out in a large cry. But if this is something that happens excessively, we can talk about having low levels of inhibitory control. And I think for children, we can often see more of the externalising side of poor inhibitory control, meaning that it’s not always so easy to detect the child that sits and ruminates over their thoughts a lot. And so, maybe we get more into that when we talk about the paper in full, but basically, that’s the idea of inhibition, that you can control thoughts, emotion and behaviours.
[00:03:31.569] Jo Carlowe: Great. Thank you. Well, let’s get into the paper itself. Can you give us an overview, what did you look at and why?
[00:03:38.920] Dr. Tone Hermansen: This paper, we found that when we have mothers who have suffered from depression, we see there’s a high risk that the child gets increased internalising or externalising behaviours, meaning that they either internalise a lot of emotions and thoughts, or they act out with externalising behaviours. And we found then that there is an important child factor in this relationship, where the child’s ability to control their thoughts and behaviours affects the strength of this relationship. And this is an important question, right? Because knowing that maternal depression may – might have some negative effects on the child’s development is just part of the uncovering of the issue, and we want to, obviously, as Psychologists, we want to know more about why this occurs, so that we can intervene.
And a lot of the prior work that has been done has, sort of, had the dominant focus on everything that happens prenatally or immediately postnatally, when the mother has either a lot of neurodevelopmental transference to the child, or when there is, sort of, very one-to-one action between the child and the infant. And what we thought is missing from the literature, but is increasingly coming, is, sort of, what happens if this is concurrent? What if it’s not only about the neurotransmitters, or the cells or the biology, but what about the modelling and the social interactions? So, that’s why we chose to delve into the slightly older children and the mothers with concurrent depression or measuring their concurrent depression.
And we chose to look at inhibitor control as one of many regulators, because there are many things we – or many capacities we have to regulate ourselves and different traditions use slightly different terminologies, and there’s a whole cohort of concepts that we could’ve looked into. And so, we used the prior literature showing hints of working memory being an important factor, for example, so ability to remember what I should do in a given situation might be important. Though, we thought inhibitor control taps into, sort of, both thoughts and behaviours, so let’s have a look at that, since it’s both thoughts and behaviours that we see are affected in children.
[00:05:48.070] Jo Carlowe: But what’s the age range?
[00:05:49.610] Dr. Tone Hermansen: We looked, then, at the preschool, five to six-year-olds. In Norway, kids start at around six, so we looked at five to six-year-old kids where mothers had – reported some level of depression, both in pregnancy or postnatally, and then later on, we measured it at the time of their visit to our lab.
[00:06:09.810] Jo Carlowe: Yeah, great, thanks for that, and can you tell us a little about – a little bit about the methodology that you used for this study?
[00:06:15.850] Dr. Tone Hermansen: We obviously have a lot of epidemiological data that we can look at in cases like this, which just gives us nice views of large samples. But I think, when it comes to learning more about the interplay between individuals, I think it’s a great value to also move beyond the questionnaires and take – and have people visit us. I call it the lab, but have them visit us as a clinic would also be a way to look at it, where we can then assess mother’s concurrent depression with a slightly more in-depth measure, and we can also have a look at the child with a slightly more challenging and less explicit task. So, we don’t have to rely on the mothers knowing how to self-report on the child’s behaviours and thoughts, but we can see the child in action.
So, we invited 100, roughly, families, into the lab and we had the child do some tasks and the mother did some questionnaires and so, we supplemented the existing literature by going slightly more in-depth.
[00:07:11.550] Jo Carlowe: Tone, what did you find? Can you share some of the key findings from your paper?
[00:07:16.069] Dr. Tone Hermansen: If we start from the baseline, the, sort of, one thing we wanted to establish here was, what is the level of maternal depression? At this point, we have found that the – they had a fairly mild level of depression, I should say. We’re not dealing with a heavily depressed sample here, and then, we measured the child’s – or had the mother’s report on the internalising and externalising behaviours of the child that they observed in the daily life. Do we find the common connection between the two, the depressive symptoms and the internalising and externalising problems? And yes, we did, we found a very strong correlation here and that’s in line with what we would’ve expected from the amounts of research that has been done here.
We also then made our model slightly more complex by introducing this measure of child inhibitory control and to see what happens if this is low versus high. So, we first ran a set of statistical analyses and saw that while it doesn’t matter so much what the level of the child is per se on the internalising and externalising levels, but when we combine this with maternal depression, that’s when we, sort of, see the interesting finding of this paper. That is when we saw that when they had low on these controlled abilities and the mother had slightly higher depression, that’s when we saw the negative effects of this depression explosion.
So, we’re, sort of, seeing that the – that maternal depression, even if low, it’s more negative on the child if the child has also some vulnerating factor and being – struggling to regulate themselves. And for the children with the higher control abilities, we saw no effect, basically. So, we didn’t see that they excelled or anything. We just saw no effects. They didn’t seem to suffer as much.
[00:08:57.770] Jo Carlowe: Yeah, that’s really interesting. The – as you pointed out, so the paper finds that children with lower levels of inhibitory control are particularly vulnerable to negative environmental influences. Can you elaborate on that finding, or why was – why is that so?
[00:09:13.680] Dr. Tone Hermansen: I think there are maybe two ways to think about this, and I’m not sure if our paper necessarily distinguishes between the two, but the one way to think about it is that when you have a poor controlled regulation mechanism yourself, you might be more simply receptive to what’s going on in the environment, right? You’re not operating on your own agenda, as clearly, for better or for worse, you’re more exposed to the negative environment, and so, if then, mothers are struggling with depression, might be slightly less responsive and respond slower and less adequately, all of these things, and then, these kind – kids might be vulnerable for that reason.
The other possibility is that they’re – and it’s related, of course, but it’s also that’s – that they’re less able to withstand, maybe, the negative influence, in the sense that when they see a modelled behaviour in their parents, low ability to, sort of, smile when there’s a happy event or to regul – so, to inhibit their own, sort of, crying or what have you, then they might struggle for that reason. And both of these might, of course, combine, as well, in these children, yeah.
[00:10:23.450] Jo Carlowe: What about children with higher levels of inhibitory control, is this protective for children in relation to maternal depression, or are they more likely to internalise rather than externalise problems?
[00:10:37.880] Dr. Tone Hermansen: That’s a interesting point, actually, I think and what this – the data doesn’t allow us to conclude that it’s a protective factor, necessarily, because that’s not really – we would’ve then needed a – some other kind of outcome measure, I think, to see if it was actually a protective one. But I think on the question of whether high inhibitory control could also be related to the high internalising problems, I think that also depends a little bit on the measurement that you use. So, that for this particular measurement here, I think we avoid that issue in the sense that, well, basically, we’re measuring your ability to control your thoughts in this particular task. If we think of internalising problems as an inability to stop ruminating thoughts, for example, well, then we shouldn’t see the association that we have here.
[00:11:26.700] Jo Carlowe: Were any of the findings surprising and if so, can you elaborate on this?
[00:11:32.079] Dr. Tone Hermansen: So, first, I enjoyed writing this paper, because we looked at theory, we looked at the evidence, made some predictions and it all seemed to fit quite nicely. I think what became surprising one was when we, sort of, start to look at the final details of the numbers of our analyses, because, for example, the maternal depression levels are fairly low in this group. So, we’re talking about a fairly mild exposure to concurrent maternal depression. I think that’s interesting that we then, still with that, see such strong negative effects on the internalising and externalising behaviours.
And also, I should say that this sample here is drawn from a population where there is a very high – medium to high socioeconomic status. I don’t have, for this particular paper, included all of this detail, but just to give you some examples, it’s – we know that their education level is fairly high. We know that they were, at the time, predominantly in partnerships, so there was social support in some way, we can assume, which is not always the case in a lot of other studies, where you can often find single parenthood and a lot of – a lower education and so on. So, it’s, sort of, a protected childhood in that sense, that you – there could be a lot of buffers that we don’t know the details of, but that are likely to be there. And still, in this sample, we find both the strong association between the maternal mental health and the child outcomes and also, still in that sample, find the child’s own contribution to this in terms of their control and regulation functions, has something to say. So, I thought that was perhaps a bit surprising, yeah, or at least very interesting.
[00:13:15.092] Jo Carlowe: Tone, is there anything else in the paper that you would like to highlight?
[00:13:17.770] Dr. Tone Hermansen: So, I think one of the things that motivated me for this paper was to try and look at slightly more transactional aspects of early childhood rearing and their early development, in the sense that we see sure that depression has some severe effects on, or can have some effects on child development. But we also see a lot of kids are doing fine, right? So, that’s – I like the kind – the opportunity to nuance that a little bit better, and I think – I have a fellow colleague, also, at the University of Oslo, Stella Tsotsi, who has done a very similar study on maternal anxiety, right, and looking at a very similar challenge that many women face, many people face, and how control ability in – within the child might be more or less making them vulnerable to this situation.
So, I think it’s nice to see papers more and more come out on, sort of, not just detecting some negative associations, so trying to work on the mechanisms and that’s what we tried to do here.
[00:14:23.540] Jo Carlowe: And what are the implications of your findings for CAMH professionals?
[00:14:27.290] Dr. Tone Hermansen: So, maybe I tap a little bit into it already with my previous answer, but I think what’s nice about this is that we can expand on our treatments a little bit, or our choices of treatment, because we don’t have the amounts of resources that are – would allow us to help everybody at a individual level.
But this is one hint at where we could target our limited resources, if we have to, and it also says something that when we create interventions or try to work with families in clinical practice, that sure, a lot of help needs to come through psychoeducation and treating of the parents and so. But there is a family dynamic to perhaps consider, that this study alludes to, that could there be training benefits of working more on control functions, not only maybe in the child, but also in the parents? In terms of implications, I think it shows that, sort of, family models for treatment are quite important, that we incorporate both parents and children, yeah.
[00:15:31.730] Jo Carlowe: Leading on from that, then, do you have any thoughts about how your findings might be translated into practice in terms of the development of treatment options and interventions?
[00:15:43.319] Dr. Tone Hermansen: One seemingly obvious thing here is that we could work more on creating training programmes for children. I just want to also emphasise that I think that’s maybe not meant as the only thing to do. It’s not the child that is the problem. That’s very important to get through. It’s more that this is an important signal to intervention studies that when we design them, we work with families and not just the mom or the child. But here, we are complementing other research that has focused a lot on the parent, yeah.
[00:16:16.350] Jo Carlowe: Are you planning any follow-up research, or is there anything else in the pipeline that you’d like to share with us?
[00:16:22.540] Dr. Tone Hermansen: So, for this particular paper, I think there are very many interesting possibilities, there – both empirically and methodologically. I mean, as I said, this is a fairly high SES background sample, so how would this look in different subgroups? And a more nuanced assessment of the impact of time, sort of, is this a prolonged depression? And it’s different if it’s a one-off. And those are things we couldn’t target in this paper, so that would be very interesting to follow-up, I think.
Specific plans are not in motion, but I also think that the other thing that I’m working more on these days is also going slightly more theoretical and deeper into the concept of when you are, in any situation, faced with conflicts between what you know and what you see, or between emotions and cognitions. How do children at this age, when we’re saying maybe we stretched the age range a little bit, four to seven, so it’s like a pre and primary school, how do children process those conflicts? How much do they extract about emotions from their context? How much do they infer from their own experiences? And those relations, I think, are very excited to work on.
So, for that, we’re actually working on some more experimental designs, with typical populations, that we can then, eventually, try out later, hopefully. Yeah, I think there are many ways to move from this paper, actually.
[00:17:45.480] Jo Carlowe: Finally, Tone, what is your take home message for our listeners?
[00:17:49.390] Dr. Tone Hermansen: An important finding from this is that it, sort of, shows us a very clear avenue for working with more targeted training or – training programmes for families. It allows us to nuance better where to place our resources if we want to and that it’s, sort of, not just a one-way street between a negative life event for one of the family members. Like the matern – mother’s struggling from depression, that they – it’s not a – it’s immediate that that has to be very negative. And there are other components to this and so, it, sort of, nuances the picture a bit more.
[00:18:24.210] Jo Carlowe: Thank you ever so much. For more details on Dr. Tone Hermansen, please visit the ACAMH website, www.acamh.org, and Twitter @acamh. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoyed the podcast, with a rating or review, and do share with friends and colleagues.