Child Adjustment Difficulties Research Articles

Psychological health of military children: longitudinal evaluation of a family-centered prevention program to enhance family resilience.

Family-centered preventive interventions have been proposed as relevant to mitigating psychological health risk and promoting resilience in military families facing wartime deployment and reintegration. This study evaluates the impact of a family-centered prevention program, Families OverComing Under Stress Family Resilience Training (FOCUS), on the psychological adjustment of military children. Two primary goals include (1) understanding the relationships of distress among family members using a longitudinal path model to assess relations at the child and family level and (2) determining pathways of program impact on child adjustment. Multilevel data analysis using structural equation modeling was conducted with deidentified service delivery data from 280 families (505 children aged 3-17) in two follow-up assessments. Standardized measures included service member and civilian parental distress (Brief Symptom Inventory, PTSD Checklist-Military), child adjustment (Strengths and Difficulties Questionnaire), and family functioning (McMaster Family Assessment Device). Distress was significantly related among the service member parent, civilian parent, and children. FOCUS improved family functioning, which in turn significantly reduced child distress at follow-up. Salient components of improved family functioning in reducing child distress mirrored resilience processes targeted by FOCUS. These findings underscore the public health potential of family-centered prevention for military families and suggest areas for future research.

Determining Risk Factors for Internalizing Problem Behavior: The Screening Instrument for Adolescents of Parents with Chronic Medical Condition

A large body of evidence suggests that the risk for adjustment difficulties in children of parents with a chronic medical condition (CMC) depend on a number of demographic, illness-related, child adaptational, and family characteristics. In particular, internalizing problems are common in children with parental CMC. This longitudinal study describes the development and psychometric properties of the Screening Instrument for Adolescents of Parents with Chronic Medical Condition (SIAPCMC), a measure intended to assess the risk for future clinical internalizing problems. Based on a meta-analysis and empirical research, risk factors for internalizing problem behavior were identified and converted into a set of key questions. Finally, questions with high predictive value for internalizing problems were selected, yielding an 8-item measure. The SIAPCMC items cover caregiving characteristics, daily hassles affecting personal life, child report of stress, active problem solving, and quality of parent attachment. From 149 adolescents (age range = 10–20 years, mean age = 15.5, number of families = 104) who participated at Time 1, 120 adolescents also completed questionnaires 1 year later (Time 2). Adolescents filled in a test battery including the SIAPCMC and the Youth Self-Report. The SIAPCMC showed excellent reliability (Cronbach’s alpha = .88–.90) and satisfactory repeated measures correlation (r = .67) over 1 year. The indices for construct and predictive validity were good. The SIAPCMC proved to be sensitive in identifying children with future internalizing problems. Our results indicate that the SIAPCMC has sound psychometric properties. The SIAPCMC should be further tested in clinical and non-clinical settings to ground its practical use for prevention of future internalizing problems.

Parental anxious expectations and child anxiety predicting homesickness during overnight summer camp

Although mild homesickness during summer camp is common, 10 to 20% of children report moderate to severe homesickness that can interfere with their functioning during camp. Previous research has considered many risk and protective factors for homesickness, including prior camp experience and coping strategies. Few studies have examined the role of parent or child anxiety. Both are associated with child adjustment difficulties in school and clinic settings, but have rarely been examined in the camp setting. This exploratory study examined parents' worries about sending their children to camp, and children's anxiety symptoms in predicting homesickness during overnight summer camp. Participants included 275 children and adolescents (7 to 14 years, 131 male and 144 female). At the beginning of camp, parents/guardians reported their anxious expectations, and children completed several items from the Screen for Child Anxiety and Related Emotional Disorders (SCARED). Near the end of camp, children reported the amount of homesickness they experienced using items from the Rate Your Day-Revised checklist. The regression model accounted for 36% of the variance in homesickness, with younger child age, less prior camp experience, higher parental anxious expectations, and greater child separation anxiety uniquely predicting homesickness. Implications for including strategies for parents in homesickness prevention programs are discussed.

Beyond Warmth and Conflict: The Developmental Utility of a Boundary Conceptualization of Sibling Relationship Processes

Translating relationship boundaries conceptualizations to the study of sibling relationships, this study examined the utility of sibling enmeshment and disengagement in predicting child adjustment difficulties in a sample of 282 mothers and adolescents (mean age=12.7 years). Mothers completed a semistructured interview at the first measurement occasion to assess sibling interaction patterns. Adolescents, mothers, and teachers reported on children's adjustment problems across 2 annual waves of assessment. Supporting the incremental utility of a boundary conceptualization of sibling relationships, results of latent difference score analyses indicated that coder ratings of sibling enmeshment and disengagement uniquely predicted greater adolescent adjustment difficulties even after taking into account standard indices of sibling relationship quality (i.e., warmth and conflict) and sibling structural characteristics (e.g., sex).

Impact of Divorce on Children: Developmental Considerations

Although divorce can have significant negative impact on children, a variety of protective factors can increase the likelihood of long-term positive psychological adjustment. • Exposure to high levels of parental conflict is predictive of poor emotional adjustment by the child regardless of the parents' marital status. • Epidemiologic data reveal that custody and parenting arrangements are evolving, with more emphasis on joint custody and access to both parents by the child. • Pediatricians' knowledge of childhood development is essential in providing anticipatory guidance to parents throughout the divorce process and beyond.

Youths with ADHD with and without tic disorders: Comorbid psychopathology, executive function and social adjustment

Attention deficit/hyperactivity disorder (ADHD) and tic disorders (TD) commonly co-occur. Clarifying the psychiatric comorbidities, executive functions and social adjustment difficulties in children and adolescents of ADHD with and without TD is informative to understand the developmental psychopathology and to identify their specific clinical needs. This matched case-control study compared three groups (n=40 each) of youths aged between 8 and 16 years: ADHD with co-occurring TD (ADHD+TD), ADHD without TD (ADHD-TD) and typically developing community controls. Both ADHD groups had more co-occurring oppositional defiant disorder than the control group, and the presence of TD was associated with more anxiety disorders. TD did not impose additional executive function impairments or social adjustment difficulties on ADHD. Interestingly, for youths with ADHD, the presence of TD was associated with less interpersonal difficulties at school, compared to those without TD. The potential various directions of effects from co-occurring TD should be carefully evaluated and investigated for youths with ADHD.

Children's Family Drawings: A Study of Attachment, Personality, and Adjustment

This study examined the relationship between children's attachment security, as manifested in their family drawings, and their personality and adjustment. Family drawings were collected from 222 Israeli children, as well as data regarding their personality and adjustment. Each drawing was coded and classified into 1 of 4 attachment categories based on global and individual characteristics such as completeness of figures, facial expression, size, and degree of movement. Results showed that drawings from securely attached children included more positive markers of personality and reflected their superior psychosocial functioning. Drawings from children in the ambivalent and disorganized attachment categories reflected the children's adjustment difficulties; children whose drawings were classified as representing avoidant attachment were found to function relatively well. The study demonstrated the effectiveness of using family drawings to assess children's attachment representations and to identify children at risk for adjustment problems in the school setting.

Assessment and management of psychosocial challenges in pediatric liver transplantation

Assessment and management of psychosocial challenges in pediatric liver transplantation

Intimate partner violence and preschoolers' explicit memory functioning.

This research examines whether parents' intimate partner physical violence (IPV) relates to their preschoolers' explicit memory functioning, whether children's symptoms of hyperarousal mediate this relation, and whether mothers' positive parenting moderates this relation. Participants were 69 mothers and their 4- or 5-year-old child (34 girls). Mothers completed measures of IPV, children's hyperarousal symptoms, parent-child aggression, and positive parenting. Measures of explicit memory functioning were administered to preschoolers. As expected, IPV correlated negatively with preschoolers' performance on explicit memory tasks, even after controlling for parent-child aggression and demographic variables related to preschoolers' memory functioning. Preschoolers' hyperarousal symptoms did not mediate the relation between IPV and explicit memory functioning, but mothers' positive parenting moderated this relation. Specifically, the negative relation between IPV and preschoolers' performance on 2 of the 3 explicit memory tasks was weaker when mothers engaged in higher levels of positive parenting. These findings extend research on IPV and children's adjustment difficulties to explicit memory functioning in preschoolers and suggest that mothers can ameliorate the influence of IPV on preschoolers' memory functioning via their parenting.

The specificity of maternal parenting behavior and child adjustment difficulties: A study of inner-city African American families.

The specificity of the association between 2 parenting behaviors (warmth and supervision) and 2 indicators, aggressive behavior and depressive symptoms, of major child outcomes (externalizing problems and internalizing problems) was examined among 196 inner-city African American mothers and their school age children. Given the growing number of African American families affected by HIV/AIDS and demonstrated compromises in parenting associated with maternal infection, the moderating role of maternal HIV/AIDS was also examined. Findings from longitudinal analyses supported the specificity of maternal warmth but not of maternal supervision. Maternal warmth was a stronger predictor of decreases in child aggressive behavior than of decreases in depressive symptoms. In addition, maternal warmth was a stronger predictor of decreases in aggressive behavior than was maternal supervision. Parenting specificity was not moderated by maternal HIV/AIDS. Clinical implications and future research directions are discussed.

Violence toward a family member, angry adult conflict, and child adjustment difficulties: Relations in families with 1- to 3-year-old children.

In this study, the authors examined whether witnessing violence toward a family member increases the risk for adjustment difficulties among children in the 1- to 3-year age range, beyond the risk attributable to witnessing nonviolent, angry adult conflict. Participants were 1,152 caregivers of 1- to 3-year-old children, randomly selected from birth records and recruited from the community. Caregivers indicated whether their children had witnessed violence toward a family member and/or angry adult conflict. They also completed a comprehensive measure of child adjustment difficulties. Exposure to violence toward a family member and exposure to angry adult conflict were each uniquely associated with increased risk for adjustment problems. These results emerged after accounting for pertinent demographic variables and for caregiver distress variables.

Impact of Hostility and Withdrawal in Interparental Conflict on Parental Emotional Unavailability and Children's Adjustment Difficulties

This multimethod, prospective study examined the nature of pathways between interparental hostility and withdrawal, parental emotional unavailability, and subsequent changes in children's internalizing and externalizing behaviors, and school adjustment difficulties over a 3-year period in a sample of 210 mothers, fathers, and 6-year-old children. The results of autoregressive structural equation models indicated that interparental withdrawal had a detrimental impact on all areas of children's adjustment, whereas interparental hostility had an indirect effect on subsequent changes in child adjustment. An intermediary role of parental emotional unavailability in links between interparental withdrawal and hostility and child outcomes was indicated, with specific, differential effects observed for fathers and mothers.

Ajustements cognitivoémotionnels familiaux face au Trouble Déficit de l’Attention et Hyperactivité (TDAH)

Background Although ADHD’s adverse impact on children’s cognitive-academic development is widely documented, its psychosocial and family implications remain comparatively understudied. Recent research suggests potential upsetting relational effects of ADHD, calling for insights into the processes underlying these effects. Aim and method This article takes on a cognitive-emotional process analysis of the current empirical research basis, to forward the understanding of relational risk and resiliency factors when children and their families confront ADHD. Results and discussion Research has so far shown evidence of three process levels through which ADHD adversely impacts on children’s psychosocial and family functioning. First, ADHD children’s cognitive-emotional adjustment difficulties appear to reflect relational correlates of functional executive control deficits underlying this disorder. Thus, ADHD tends to affect the child’s interaction regulation abilities as regards adequate contextual analysis, control over undesirable behaviour and learning from relational feedback. According to a diathesis stress model, such adjustment difficulties in ADHD children may constitute an important risk factor toward family and social interactions. Second, families tend to confront adjustment difficulties in their relational dynamics when children’s ADHD-manifestations remain insufficiently understood. Overall, studies document an increased incidence of negative family perceptions and interactions in the context of ADHD. There is a tendency of parents to adopt a coercive educational model when attempting to adjust family functioning to their child’s “disruptive” behaviour. While a spiral of negative interaction dynamics thus often reflects family members’ difficulties in adapting efficiently to the child’s behaviour, research demonstrates both direct-ADHD and indirect-comorbidity-related effects in this context. This third level of analysis allows recognition of multiple child- and parent-level comorbidities, which add transactional complexity to family dynamics. Attention-Deficit–Hyperactivity Disorder is indeed frequently associated with comorbidities, including children’s oppositional-aggressive behaviour and/or parental psychopathology such as ADHD, depression, antisocial behaviour or Bipolar Disorders. Family members’ adjustment abilities as well as overall quality of life tend to suffer from such cumulative, reciprocal risk effects or, on the opposite, may remain buffered by their absence. Although findings regarding directionalities through which multiple-entry factors operate need further clarification, research highlights differential impacts of ADHD as a function of the severity of its core manifestations and the extent and type of comorbidities in the entire family. In terms of clinical implications, discussed findings underscore the importance of sufficiently acknowledging the strain of adjustment challenges associated with ADHD on a family level. In view hereof, systematic family assessment is commendable in order to account comprehensively for “descriptive” psychopathology but also for family members’ own experiences when facing ADHD. Child and parent abilities to deal with ADHD could be enhanced by modulated therapeutic approaches that stimulate development of adequate cognitive-emotional analysis and response options, as illustrated by our current multisite European FACE© programme (for Facilitating Adjustment of Cognitions and Emotions). In conclusion The extant literature calls for closer attention to the context of family pathways through which ADHD comes to represent a significant risk factor for families’ quality of life. Our analysis underscores the need for a clinical approach that integrates systematic assessment and monitoring of families’ adjustment processes, to foster efficiency of interventions that may help children and their families face ADHD along with its potentially pervasive implications.

Domestic Violence and Children's Adjustment

SUMMARY This article presents a review of the empirical literature on the effects of witnessing domestic violence on children's adjustment. The review includes 47 studies published in the last two decades. Although there are some inconsistent findings in early research, there is less inconsistency in more recent studies which employ standardized measures, comparison groups of children, and more sophisticated data analytic techniques. Results show that children exposed to domestic violence generally have more emotional and behavioral problems, less social and cognitive competence, and exhibit more health problems than children not exposed to domestic violence. Important methodological and theoretical challenges in this area of research are discussed. Suggested priority areas for future research include: studying nonshelter samples of children exposed to domestic violence, studying the effects of children's exposure to interparental verbal and other forms of aggression, conducting longitudinal research to examine the effects of domestic violence on children's long-term adjustment and to elucidate what factors, if any, ameliorate or exacerbate children's adjustment difficulties.

Discrepancy between mother and child perceptions of their relationship : II. Consequences for children considered within the context of maternal physical illness

Discrepancies between parent and child perceptions of parenting have been well established. The current study addressed whether discrepancies in one dimension of parenting, the parent-child relationship, are associated with child adjustment difficulties concurrently and longitudinally. In particular, it was hypothesized that greater discrepancies in mother and child perceptions of parenting would be associated with child adjustment difficulties. Furthermore, it was hypothesized that families experiencing a stressor—in this case, maternal infection with the human immunodeficiency virus (HIV)—would experience larger discrepancies than families in which the mother is noninfected and that maternal HIV infection would moderate the association between discrepant views and child adjustment. Participants were 183 African-American women (61 HIV infected; 122 noninfected) and one of their noninfected children. All participants were from the inner-city area of New Orleans. Results indicated that discrepancies in mother and child perceptions of their relationship was associated with mother and child reports of externalizing behavior problems concurrently and longitudinally. In addition, discrepancies were significantly higher in families experiencing maternal HIV infection than in the noninfected group. However, with one exception, maternal HIV status failed to moderate the relationship between discrepancies in perception and child adjustment, indicating that discrepancies play a similar role in both types of families. Clinical implications of the present results are discussed.

Parental warmth, control, and indulgence and their relations to adjustment in Chinese children: a longitudinal study.

A sample of children, initially 12 years old, in the People's Republic of China participated in this 2-year longitudinal study. Data on parental warmth, control, and indulgence were collected from children's self-reports. Information concerning social, academic, and psychological adjustment was obtained from multiple sources. The results indicated that parenting styles might be a function of child gender and change with age. Regression analyses revealed that parenting styles of fathers and mothers predicted different outcomes. Whereas maternal warmth had significant contributions to the prediction of emotional adjustment, paternal warmth significantly predicted later social and school achievement. It was also found that paternal, but not maternal, indulgence significantly predicted children's adjustment difficulties. The contributions of the parenting variables might be moderated by the child's initial conditions.

Family moderators of the relation between hassles and behavior problems in inner-city youth

Examined family moderators of the relation between everyday stressors (hassles) and behavior problems in 99 inner-city children (ages 8-12 years, M = 10.7) and their caregivers. In separate home interviews children reported on their everyday stress, perceived support from mother, and adjustment problems; mothers reported on family demographics, major life stressors, family interaction patterns, and child adjustment difficulties. Higher levels of cohesion and routines attenuated the relation between hassles and both internalizing and externalizing problem behaviors, whereas high family conflict exacerbated the risk for adjustment difficulties. For externalizing behavior, higher levels of family adaptability protected children from the impact of daily hassles. Social support from the mother did not moderate the hassle-adjustment association. Implications for interventions with families are discussed.

The Spanish Version of the Social Competence and Behavior Evaluation (SCBE)-Preschool Edition: Translation and Field Testing

This article describes the Spanish translation process and field testing of the Social Competence and Behavior Evaluation (SCBE)-Preschool Edition. This teacher-completed standardized instrument, available in French and English, assesses patterns of social competence, affective expression, and adjustment difficulties in children between the ages of2 years, 6 months and 6 years, 6 months. An initial study of225 children compared results of evaluations of the same children with the Spanish and English versions of the instrument. The results yielded psychometric data showing that the Spanish version has satisfactory internal consistency and test-retest reliability and detects comparable gender differences in adaptation similar to the French and English versions. A generalization study of 414 children recruited in Spain and the United States confirmed the robustness of the instrument and demonstrated that its factor structure corresponds closely to that of the other versions.

Chronic family adversity and early child behavior problems: a longitudinal study of low income families.

A beginning step in the prevention of child psychopathology is the identification of conditions associated with a disproportionately high incidence of behavior problems. Rutter and colleagues (British Journal of Psychiatry, 1975, 126, 493-509) have reported a dramatic increase in the probability of child adjustment difficulties as a function of multiple family stressors. However, few investigators have tested this association beginning in infancy. The present investigation examines this relationship at the ages of 1 and 2 with behavioral adjustment at age 3 among 100 low-income families. Broad support was found for the family adversity hypothesis, though sex differences were evident regarding individual correlates of problem behavior.

Chronic family adversity and infant attachment security.

A beginning step in the prevention of psychopathology in children is the identification of conditions and events associated with a disproportionately high incidence of behavior problems. Rutter, Cox, Tupling, Berger and Yule (1975a, British Journal of Psychiatry, 126, 493-509) have reported a dramatic increase in the probability of children's adjustment difficulties as a function of multiple family stressors. However, this association has never been tested with infants. Among instruments of infant behavior, attachment classification has been found to be a significant predictor of later adjustment problems, particularly among low-income samples. The present investigation examines the relation between six significant familial stressors and infant attachment security in a sample of 100 low-income parent-infant dyads. Family stressors included parental criminality, maternal depressive symptomatology, maternal personality risk, overcrowding in the home, and the quality of the relationship with a significant other. Cumulative family adversity was found to differentiate secure from insecure infants, but only among families with three or four stressors present. There also was moderate support for one hypothesis derived from attachment theory, namely that stressors more closely associated with maternal functioning are more common among families with insecurely attached infants. Conceptual links between stressors and attachment are discussed, including pathways by which chronic stressors may interfere with the formation and maintenance of secure mother-infant attachment relations.