Linking Developmental Delays and Parenting Strategies With Inclusivity in Mind

How do parents adjust their behavior in the context of neurodiversity? 

Under the Cortex features Alexandra Sullivan (University of California, San Francisco), a psychological scientist who studies the link between parenting and developmental delays. In this episode, Sullivan and APS’s Özge G. Fischer-Baum discuss parenting strategies with an inclusive approach. 

Sullivan also recently published an article on this topic in APS’s journal Psychological Science

Unedited transcript

[00:00:12.850] – APS’s Özge G. Fischer Baum  

Parenting practices and their consequences have interested many individuals and professionals for decades. Clearly, there is no one size fits all approach to parenting. What is the role of parenting in context of neurodiversity and developmental delays? What are the lessons that recent scientific studies can tell us? I am Özge Gürcanlı Fischer Baum with the Association for Psychological Science. This episode of Under the Cortex features Alexandra Sullivan, a psychological scientist at the University of California, San Francisco who has studied the link between parenting and developmental delays. She recently published an article on this topic in APS’s journal Psychological Science. Alexandra, welcome to Under the Cortex. 

[00:01:03.270] – Alexandra Sullivan 

Thank you so much for having me. 

[00:01:05.300] – APS’s Özge G. Fischer Baum  

Your research explores the link between parenting practices and developmental delays. How do you define developmental delays? What type of delays have you looked at in your research? 

[00:01:17.690] – Alexandra Sullivan 

That’s a great question. So developmental delays describe when a child is slow to reach a milestone relative to their same age peers. An example I like to use is that you might notice a child who has experienced a lot of hearing difficulties in infancy. This child may have a harder time understanding and creating language. So my research focuses largely on how stress gets under the skin and how parents can help children be healthy even when they’re coping with a lot of stress. Children with developmental delays are really relevant to my research in that we see developmental delays in families who are coping with a lot of stress. So developmental delays are more common in context of poverty and stress, and parenting kids with developmental delays can be extra challenging. 

[00:02:07.370] – APS’s Özge G. Fischer Baum  

Right. And I was going to ask you, when was the first time you came up with the idea of connecting these two things? 

[00:02:15.690] – Alexandra Sullivan 

So my research builds upon some foundational work that my colleagues, Drs. Jon Comer and Dan Bagner at Florida International University did. They did the parent study for the study that we’re talking about today, which was published this January in JAMA Pediatrics, where they looked at whether or not an Internet based parenting intervention could support health in kids and families where kids had a developmental delay? Largely because of this link that I just articulated that parents who parent children with developmental delays experience a lot of stress, and children with developmental delays are more likely to be growing up in situations where there’s a lot of poverty and stress. And finally, what we see in this whole situation is that children with developmental delays are more likely to have challenges with behavioral problems down the road. If we go to that example of a child who might have a hard time producing language, it’s really frustrating to not be able to communicate the words that you want to. And so sometimes what we see in those contexts are kids can act out because they don’t have the right words. And so you can see how this might set kids up on a pathway to perhaps engage in behaviors that aren’t so helpful and might get them in trouble with their peers. 

[00:03:34.550] – APS’s Özge G. Fischer Baum  

Right. And it adds additional stress to something like parenting, which is already stressful. 

[00:03:41.400] – Alexandra Sullivan 

Especially with the demands of a kid with developmental delay. 

[00:03:45.530] – APS’s Özge G. Fischer Baum  

Yeah. Let’s talk about the parenting side of things a little bit. Your research categorizes parenting behavior as positive and negative parenting practices. What are the main differences between these two categories? 

[00:04:01.630] – Alexandra Sullivan 

A positive strategy might be specifically praising your kid for something that you really love to see or tuning in really closely if your kid is playing in a way that’s really awesome and you like to see, to show your kid that you’re paying attention to them. So those would be something that we’d call positive strategies. Negative strategies, especially for little kids, can be giving too many instructions. Of course, we have to instruct kids, but if we give instruction after instruction, it’s a lot for brains that are growing to process criticism. We get that raising children is incredibly frustrating, but offering criticism or saying things that are more negative or critical can be less helpful in helping direct children towards behaviors that are helpful for them. So, positive strategies are those things that we love to see more of the praise, paying close attention, and negative. Are those things like criticisms or too many instructions? 

[00:05:03.970] – APS’s Özge G. Fischer Baum  

And I will come back to this, but there is one other notion that you use in your study. You talk about epigenetic age acceleration. What does it mean, and why is it important to know? 

[00:05:20.710] – Alexandra Sullivan 

Okay. Epigenetic age acceleration is a very long term to describe this really cool concept. And let me just take a step back to help everybody understand what we’re talking about here. So, take the example of a kid on their fifth birthday. The calendar would say that this child is five years old. However, if we look inside this child’s cells, what we might actually see are markers that this kid’s body is older than five. Let’s say five and a half. So this kid, on their fifth birthday, their calendar age says five, but their cells say 5.5. We would think that this kid is showing biological age acceleration. Their body’s a half year older than the calendar says it is. Epigenetic age acceleration is one way of measuring this biological age acceleration. And it’s particularly helpful with child samples because we can get it from cheek swaps, which are relatively easy to take from little kids. It’s a little less scary than blood, so one thing that I like to think about here, especially in context of stress, having accelerated age might be really helpful. It can help them survive and function. However, all these things that our body does to help us hang on in times of stress often come with consequences. 

[00:06:39.430] – Alexandra Sullivan 

And so what we actually see in the research is accelerated aging often associates with a lot of health problems. We see this mostly in adult samples, but growing evidence in kids samples where kids with this accelerated biological aging might be more likely to have psychological problems, asthma, or different other physical health indicators. In my research, which largely focuses on stress and parenting interventions, and how these parenting interventions can actually get under kids skin, tools like epigenetic age acceleration are really helpful in seeing kids responses to stress, as well as the potential for an intervention to help their body heal in the context of stress. 

[00:07:24.110] – APS’s Özge G. Fischer Baum  

Yeah. So that is very interesting, and you mentioned this in the passing, but I would like to hear it with a clear link that you found between the parenting practices and developmental delays. What are your main results? 

[00:07:40.930] – Alexandra Sullivan 

So, our main results in this study was that we looked at different levels of stress children were experiencing, and we found that in kids who reported experiencing more stress, these kids showed lower epigenetic age acceleration when their parents showed increases in positive parenting practices or decreases in negative parenting practices over time. So to say it a little more simply and a little more concisely, in kids who reported more stress, improvements in parenting seemed to relate to lower biological aging. 

[00:08:25.410] – APS’s Özge G. Fischer Baum  

So, in other words, when parents work on their parenting with intentional practices, we see that children receive that well, they have less stress, and therefore, we don’t see epigenetic age acceleration. 

[00:08:41.740] – Alexandra Sullivan 

Yeah, or we see lower levels. Slower levels. Exactly. And this was really evident in our sample, in the kids who were reported higher levels of stress. This effect wasn’t super large in the kids who reported lower levels of stress. So that’s another thing that I like to think about. 

[00:08:58.990] – APS’s Özge G. Fischer Baum  

All right. And your study is based on us population. Do you expect similar or different results in the other regions of the world? 

[00:09:08.910] – Alexandra Sullivan 

That’s a really great question and something that I think about a lot, because this is a us population, but specifically, it was a mostly Latinx population of kids in the southeast US. So does that even generalize to different subgroups of the US population, which we know is very diverse? So what I think about here is if we measure parenting thoughtfully in a culturally sensitive way, I think the messages in this study would generalize, but I think it might look different in different populations because parenting doesn’t look the same. What’s helpful for some kids in some contexts is not always the same as what’s helpful in another kid growing up in another context and then taking another step back. These processes might not necessarily show up in kids who are coping with severe safety concerns if they’re growing up in the context of war or severe, really physical stress. It may be that supporting parenting is helpful, but perhaps not nearly enough, rather than preventing that overall stress that those kids are being exposed to. 

[00:10:19.110] – APS’s Özge G. Fischer Baum  

Yeah, and based on your research and your practical work, you already mentioned interventions. What type of parenting interventions would you imagine to change their family dynamics constructively? 

[00:10:33.930] – Alexandra Sullivan 

I think about this a lot. My boss calls me a big parenting nerd. I’m trained in a few different parenting interventions, but my favorite work has always been in a pediatric healthcare clinic. So sometimes I’ve worked with pediatricians to do really quick interventions with kids and families who, rather than these longer 1020 session interventions and the interventions that seem to be the most effective from the research and from my experience, are the ones that teach parents to very intentionally spend special time with their kids or really spend focused, positive time with their kids. And this can look like five minutes a day, it’s not like 3 hours. So, interventions that increase the quality and the quantity of one on one, really attentive time, and interventions that decrease unhelpful practices. The most common thing that I really like to help support parents in decreasing is when you’ll often find, in situations where parents are reporting that their kids are acting out a little bit more. Kids tend to be getting a fair amount of attention, understandably, but somewhat negative attention from when they act out. So if we can teach parents this incredibly difficult skill called active ignoring, where they take their attention away from a minor, frustrating behavior, and instead really focus their attention on these more neutral or helpful or bonding behaviors that can be really helpful for family systems, there are a bunch of different programmatic parenting interventions. 

[00:12:13.120] – Alexandra Sullivan 

The one in this study was called, it was an Internet version of parent child interaction therapy, which is a really well received intervention in the community. There’s other interventions like helping the non compliant child parenting, the strong willed child attention, and then there’s also attachment and biobehavioral catch up. So there’s a bunch of different programs that package these skills in different ways, but the crux of it is really supporting parents in increasing the quality of that time they spend together. And it can really even just look like five minutes a day and decreasing the amount of times they engage in accidentally reinforcing their kiddo’s misbehaviors. 

[00:12:55.110] – APS’s Özge G. Fischer Baum  

All right, so five minutes a day. That is promising, having this intentional relationship with your child for five minutes. I think this can be a good take home for our listeners. 

[00:13:05.840] – Alexandra Sullivan 

Oh, I love it. It’s called special time, if parents want to look it up, where we basically prescribe a daily dosage of five minutes of really kind of like zoning in on their kid. We often use the analogy of, like, a sportscaster, like, describing what their kid is doing. Again, the point is we focus on behaviors we want to see the kid do. The trick is to not put attention on misbehavior, because kids love attention, and anything they get attention for, they’re going to increase. So ideally, we really zone in that intention on playing well with their parent or their sibling or with the blocks. 

[00:13:45.750] – APS’s Özge G. Fischer Baum  

Yeah. And you are a researcher currently, right. I assume you are going to do more research in this area. What are your next steps? 

[00:13:57.850] – Alexandra Sullivan 

So my next step is to look at this question that we asked in the study in a bigger sample to see if we can really isolate if it is the intervention that’s causing this effect experimentally and then to continue to expand going forward. My research program really focuses on those interactions between biological systems and parenting behaviors and how that can support child’s health. 

[00:14:25.510] – APS’s Özge G. Fischer Baum  

And again, you mentioned in the pacing that you work with clinical groups. Do you work with any advocacy groups, or do you share your findings with other collaborators? 

[00:14:40.250] – Alexandra Sullivan 

So right now, part of my research at the University of California, San Francisco is through the Intergenerational Developmental Health program. So this program is a new program which is led by my mentor, Dr. Nicole Bush, and it conducts science and works with policymakers to support effective prevention and access to whole family health care, with the eventual goal of supporting children’s mental and physical health. So we really strongly believe that prevention is the best. If we could prevent these stress exposures in the first place, a lot of times these interventions wouldn’t necessarily be what we need. But in cases where prevention isn’t possible, a lot of times in order to treat kids health, we really have to think about the whole family system. So these parenting interventions or thinking about maternal mental health and how that might impact her whole family. So we have a really great website that summarizes a lot of the science and advocacy that we do in this realm. It’s at devHealth,, and you can go there to learn a little bit more about our research and advocacy. 

[00:15:48.510] – APS’s Özge G. Fischer Baum  

Okay, great. Is there anything else that you would like to share with our listeners? 

[00:15:56.370] – Alexandra Sullivan 

The primary thing that I just want to make sure to really hit home is that children exposed to adversity that can really show up in their bodies. However, parents have an incredible capacity to be able to help attenuate or buffer that stress and how it shows up in kids. And I think it’s really important to remember. One of the coolest messages that was pointed out to me when I was talking about these findings at a conference was that we found these effects to be strongest in families that were coping with the most stress, suggesting that parents who are coping the most stress had this amazing capacity to engage in these positive parenting practices. It speaks to how powerful and heroic parents can be in supporting their kids health. And so I think that’s a really important message to remember that parents are doing amazing work, even in context of a lot of stress. 

[00:16:55.830] – APS’s Özge G. Fischer Baum  

And yeah, that is an important point, like you say. So knowing about these practices and applying them also helps the parents. 

[00:17:04.870] – Alexandra Sullivan 

Yes, and in other realms of research, we see signs that engaging in these effective practices and connecting more with their kids can be really helpful for parents. It can be hard raising a kid who acts out or has these tendencies to misbehave. But then when parents learn to reframe and to interact with their kids in different ways, I’ve noticed, especially in clinical interactions, they remember how much they really like their kid. I’ve heard from more than one parent, I always have loved my child, but this really helped me realize how much I liked my child. 

[00:17:41.250] – APS’s Özge G. Fischer Baum  

Oh, that’s great. Well, Alexandra, thank you very much. This was a lovely conversation. 

[00:17:47.830] – Alexandra Sullivan 

Thank you so much for having me. I really enjoyed talking through the findings with you. 

[00:17:51.880] – APS’s Özge G. Fischer Baum  

This is Özge Gürcanlı Fischer Baum with APS and I have been speaking to Alexandra Sullivan from University of California, San Francisco. If you want to know more about this research, visit 

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