Aggressive Behavior Problems Research Articles

Revisiting the 8-syndrome of the Child Behavior Checklist (CBCL) in 67257 Chinese school students

ABSTRACT The 8-Syndrome structure of the Child Behavior Checklist (CBCL) has been well supported globally, but its validity in the Chinese sample remains untested. A total of 67,257 school students aged 6–16 were included. The Chinese version of the CBCL consists of 118 specific behavioral and emotional items, with two open-ended screening items. Confirmatory factor analysis (CFA), cluster analysis, and network analysis were employed to test the 8-Syndrome structure in the Chinese CBCL. The Chinese CBCL showed a comparative fit index (CFI) of 0.734, indicating poor fit in the Chinese sample. Cluster and network analyses suggested that Anxious/Depressed (AD), Withdrawn/Depressed (WD), and Thought Problems (TP) might form internalizing factors (representing emotional or thought problems), whereas Aggressive Behavior (AB), Rule-Breaking Behavior (RBB), and Attention Problems (AP) might comprise externalizing factors (representing behavioral problems). Age emerged as a significant factor influencing emotional and behavioral problems in the Chinese sample (p < 0.05). The 8-Syndrome structure of the Chinese CBCL did not fit well, prompting the need for further exploration and possible restructuring across different samples. Definitions of Internalizing and Externalizing factors may require refinement and age considerations should be integrated into future revisions of the CBCL structure.

Gender differences in behavioral and emotional problems among school children and adolescents in China: National survey findings from a comparative network perspective

BackgroundBehavioral and emotional problems are common and often co-occur during childhood and adolescence. The aim of this study was to assess gender differences in the network structures of behavioral and emotional problems of children and adolescents in China based on a national survey. MethodsThe Parent version of Achenbach' s Child Behavior Checklist (CBCL) was used to assess behavioral and emotional problems. To account for potential confounding factors in comparisons between boys and girls, propensity score matching was utilized. Network model differences were assessed using Network Comparison Test (NCT). ResultsData from 60,715 children and adolescents were included for analyses. Boys exhibited more severe total behavioral and emotional problems compared to girls. While several edges showed significant differences between boys and girls, the strongest association was consistently found between “Attention problems” (CBCL6) and “Aggressive behavior”(CBCL8) in both boys and girls, regardless of age. Network centrality was higher among adolescents compared to children. The most central problems commonly found across different genders and age groups were “Aggressive behavior” (CBCL8) (centrality values were 1.142 for boys aged 6–11 years, 1.051 for boys aged 12–16 years, 1.148 for girls aged 6–11 years, and 1.028 for girls aged 12–16 years), “Anxious/depressed” (CBCL1) (centrality values of 0.892 for boys aged between 6 and 11 years, 1.031 for boys aged 12–16 years, 0.951 for girls aged 6–11 years, and 1.099 for girls aged 12–16 years) and “Social problems” (CBCL4) (centrality values of 1.080 for boys aged 6–11 years, 0.978 for boys aged 12–16 years, 1.086 for girls aged between 6 and 11 years, and 0.929 for girls aged 12–16 years). ConclusionTesting effective interventions that address aggressive behavior, anxiety/depression, and social problems may be beneficial for reducing risk of psychopathology among children and adolescents.

Machine learning algorithms to the early diagnosis of fetal alcohol spectrum disorders.

Fetal alcohol spectrum disorders include a variety of physical and neurocognitive disorders caused by prenatal alcohol exposure. Although their overall prevalence is around 0.77%, FASD remains underdiagnosed and little known, partly due to the complexity of their diagnosis, which shares some symptoms with other pathologies such as autism spectrum, depression or hyperactivity disorders. This study included 73 control and 158 patients diagnosed with FASD. Variables selected were based on IOM classification from 2016, including sociodemographic, clinical, and psychological characteristics. Statistical analysis included Kruskal-Wallis test for quantitative factors, Chi-square test for qualitative variables, and Machine Learning (ML) algorithms for predictions. This study explores the application ML in diagnosing FASD and its subtypes: Fetal Alcohol Syndrome (FAS), partial FAS (pFAS), and Alcohol-Related Neurodevelopmental Disorder (ARND). ML constructed a profile for FASD based on socio-demographic, clinical, and psychological data from children with FASD compared to a control group. Random Forest (RF) model was the most efficient for predicting FASD, achieving the highest metrics in accuracy (0.92), precision (0.96), sensitivity (0.92), F1 Score (0.94), specificity (0.92), and AUC (0.92). For FAS, XGBoost model obtained the highest accuracy (0.94), precision (0.91), sensitivity (0.91), F1 Score (0.91), specificity (0.96), and AUC (0.93). In the case of pFAS, RF model showed its effectiveness, with high levels of accuracy (0.90), precision (0.86), sensitivity (0.96), F1 Score (0.91), specificity (0.83), and AUC (0.90). For ARND, RF model obtained the best levels of accuracy (0.87), precision (0.76), sensitivity (0.93), F1 Score (0.84), specificity (0.83), and AUC (0.88). Our study identified key variables for efficient FASD screening, including traditional clinical characteristics like maternal alcohol consumption, lip-philtrum, microcephaly, height and weight impairment, as well as neuropsychological variables such as the Working Memory Index (WMI), aggressive behavior, IQ, somatic complaints, and depressive problems. Our findings emphasize the importance of ML analyses for early diagnoses of FASD, allowing a better understanding of FASD subtypes to potentially improve clinical practice and avoid misdiagnosis.

Metode Bimbingan Konseling Islami dalam Mencegah Perilaku Agresif pada Anak Berkebutuhan Khusus di Athaya Medan

This research is entitled "Islamic Counseling Guidance Methods in Preventing Aggressive Behavior in Children with Special Needs at Athaya Medan". The aim of this researh is to find out how Islamic counseling guidance methods are carried out in the process of preventing aggressive behavior in children with special needs, the inhibiting factors in the process of implementing Islamic counseling guidance, the impact of the results of Islamic counseling guidance, and the solutions to the aggressive behavior problems experienced by children with special needs at Athaya Medan. This researh is a field study with qualitative research. The research informants in this study are the Founder of ABK Athaya and also the counselor for children with special needs. Data collection for this research uses interview, observation, and documentation methods. Primary data sources are obtained from related research informants and secondary data sources are obtained from documentation, books, or literature related to this research. Data analysis techniques in this study include data reduction, data presentation, and conclusions. The results of this study show that the Islamic counseling guidance carried out by counselors for children with special needs includes therapy, learning to read Arabic letters, brain training skills, and playing with motor/educational toys. Children with special needs are also encouraged to do muhasabah (evaluate, reflect on the essence of themselves, and their attitudes and behaviors at present, which are in line with their condition, encouraged to think about what is best for them, so that they can achieve happiness in this world and the hereafter). Inhibiting factors that occur in communication in conveying language are very difficult and also difficult to understand, so guidance must be repeated. The success of guidance is seen in the improvement of emotional development or better behavior exhibited by children with special needs both in the school environment and outside the school environment by conducting Islamic counseling guidance in preventing aggressive behavior towards solutions to the problems faced by children with special needs.

Coping Power-Rural: Iterative Adaptation of an Evidence-Based Preventive Intervention for Rural Upper Elementary and Middle Schools

BackgroundEducators in rural schools are uniquely situated to address youth mental health disparities, yet often face challenges in delivering mental health supports. This paper describes the process of adapting the evidence-based Coping Power program, a small group prevention program for youth with aggressive behavior problems, to be a two-tiered (Tier 1 and Tier 2), transdiagnostic intervention to improve fit and feasibility for rural upper elementary and middle schools.MethodIdentified challenges with the Coping Power program for rural areas included program length, substantial staffing and resource requirements, lack of universal programming, low caregiver engagement, and co-occurring problems. Initial adaptations included a classroom and small group format implemented by school staff, teacher consultations integrated into coaching and co-facilitation, and a technology-supported caregiver component. Implementer feedback forms, coaching notes, and individual interviews informed the iterative development and feasibility testing process.ResultsBetween 2019 and 2023, thirteen schools across six rural districts implemented the program. Student curriculum revisions included order and relative emphasis of content, classroom and small group overlap, necessary simplification of concepts, improved contextualization to the rural setting, and the addition of student workbooks. Supports for implementers included fully developed lesson plans and slides, a comprehensive implementation manual, video lesson overviews, action-focused training, and a 3-session coaching model to support implementer preparation and sustain motivation. Teacher and caregiver infographic text “nudges” were improved to promote generalization of concepts across settings.DiscussionBy partnering with school-based implementers, the adapted program holds promise to be more feasible and appealing for rural schools than the original model. This fully developed program is now ready for larger-scale testing in rural schools.

Maternal childhood trauma and toddlers’ behavioural and endocrine reactions to a crying baby doll

BackgroundChildhood trauma can have long-term consequences for survivors, but also for survivors’ children. Children of childhood trauma survivors are more likely to develop aggressive and antisocial behaviour problems, indicating that parents’ childhood trauma may affect children’s social development. Less is known, however, about how maternal childhood trauma may affect positive aspects of children’s social behaviour, like their empathic and prosocial responses to witnessing others’ distress. Additionally, some studies suggest that maternal childhood trauma may also affect children’s physiology, particularly their endocrine responses to (dis)stress. We therefore examined the link between maternal childhood trauma experiences and children’s behavioural and endocrine responses to witnessing distress in others. MethodsWe recruited 75 mothers with 12-24 month-old toddlers. Mothers’ childhood trauma experiences was assessed and toddlers were exposed to a realistic-looking, crying baby doll, to assess their levels of distress, empathic concern for, and prosocial behaviour towards the doll. Saliva samples were taken two times prior to and one time 25minutes after exposing children to the crying doll, to assess toddlers’ baseline and reactivity cortisol concentrations in response to the crying doll. ResultsData analysis is still ongoing. The results contribute to understanding whether maternal childhood trauma can affect children’s behavioural and endocrine responses to others’ distress. ConclusionTo the best of our knowledge, this is the first study examining whether maternal childhood trauma can affect children’s responses – both behavioural and endocrine – to others’ distress. Our study may contribute to understand the intergenerational effects of childhood trauma on child social development.

Youth Aggression and Peer Victimization as Predictors of Adolescent Alcohol and Marijuana Use: A Longitudinal Analysis of Youth with Aggressive Behavior Problems.

Youth who are behaviorally aggressive and victimized by their peers comprise a significant population with specific risks and vulnerabilities relative to substance use. The goals of the current study were to examine the roles that youth aggression and peer victimization play in determining the timing of alcohol and marijuana use initiation and the frequency of use 5-years later in a sample of at-risk, aggressive youth. 360 youth (Mage= 10.17 years; 65% boys, 35% girls; 78.1% African American, 20.3% Caucasian, 1.4% Hispanic, and 0.3% other) recruited for a prevention program for at-risk youth were followed for 5 years (4th - 9th grade). Cox PH regressions were conducted to predict timing of alcohol and marijuana use initiation. Zero-inflated negative binomial regressions were used to predict frequency of alcohol and marijuana use 5 years later. Results showed that peer victimization inferred decreased risk of alcohol use initiation. However, this effect was only observed for youth with relatively moderate, and low levels of aggression. Findings suggest that differences in youth aggression and victimization interact to predict distinct outcomes, suggesting the need for a more comprehensive approach when working with aggressive youth who have experienced peer victimization.

초기누적위험요인이 어머니의 사회적 양육행동을 매개로 유아행동발달에 미치는 영향

Objectives In this study, we examined the longitudinal impact of early cumulative risk factors on child behavioral development and confirmed whether the mother's social parenting behavior played a mediating role in that process.&#x0D; Methods For 1,434 children and households participating in the Korean Children's Panel, early cumulative risk factors were assessed in the first year's data, mothers' social parenting behavior was assessed in the fourth year's data, and child behavior development was assessed in the fifth year's data(Korean version of the Child Behavior Assessment Scale: CBCL 1.5-5) was used. The initial cumulative risk factors, which are composed of eight risk factors, are the mother's response to basic livelihood security recipients and the next lower class, mother's education level, mother's marital conflict, mother's depression, mother's parenting stress, mother's self-esteem, social support, and family life event was used. Data analysis was performed by conducting mediation regression analysis using Model 4 of Process Macro v4.0.&#x0D; Results In the longitudinal impact of early cumulative risk factors on child behavior development, mothers' social parenting behavior partially mediates infants' internalization, externalization, emotional reactivity, anxiety/depression, physical symptoms, withdrawal, attention problems, aggressive behavior, and other problems. It was found to play a partial mediating role, and sleep problems were found to play a complete mediating role.&#x0D; Conclusions The mother's social parenting behavior was found to have a significant impact on the child behavioral development in the long term by acting as a mechanism to transmit the effects of an unfavorable home environment with early cumulative risk factors to the child. Therefore, we discussed ways to restore and support mothers' social parenting behavior to prevent the long-term negative impact of an unfavorable family environment with early cumulative risk factors on child behavioral development.&#x0D;

Prevention of Child Maltreatment: Integrative Review of Findings From an Evidence-Based Parenting Program.

This integrative review of the ACT Raising Safe Kids (ACT)-child maltreatment prevention program for parents-focuses on the program's theoretical framework, examines the ACT studies about the effects on caregivers, and discusses the ACT's implications for the practice and public policy. A systematic search of the PubMed, Web of Science, PsycINFO, and Lilacs databases was performed, along with a search on the ACT Program website and contacting program researchers. Twenty-five studies evaluating the ACT Program were reviewed. The evaluation studies were conducted in the United States, Brazil, Portugal, and Peru. The program improved parenting practices in general and targeted populations such as incarcerated parents, mothers with a history of childhood violence, and mothers of preterm children. Additionally, the program was effective in decreasing child behavioral problems. Overall, the ACT Program effectively decreased hostile, aggressive, and coercive parenting and child behavior problems, which are key predictors of family violence.

Moderating Effects of Emotional Recognition Competency in Rejective Parenting and Adolescent Depression and Aggression.

Rejective parenting is a major antecedent of emotional instability and aggressive behavioral problems. Previous studies have reported that emotional problems, such as depression, anxiety, aggression, and conduct problems in children and adolescents, improve through interventions that enhance emotional recognition competency. In this study, we explored whether the emotional recognition ability levels of individual adolescents moderated the pathway of negative parenting on aggression mediated by depression The moderated mediating effect of emotional recognition competency was investigated through examining 2265 first-year high school students using the 2021 data from the Korean Children and Youth Panel Survey 2018. There was no significant moderating effect on the direct pathway from rejective parenting to aggression. The moderating effect of emotional recognition competency on the indirect pathway leading to aggression through depression in rejective parenting was significant. These results suggest that the ability to correctly understand signals related to the emotions of others can play an important role in reducing depression and aggressive behavior by reducing conflict with people around them and experiencing more support.

Parenting Style and Child Aggressive Behavior from Preschool to Elementary School: The Mediating Effect of Emotion Dysregulation

AbstractParenting styles act as a risk or a protective factor for the development of aggressive behavior problems in children. Moreover, children with deficits in emotion regulation often show increased aggressive behaviors. Previous studies confirm that parenting style also contributes to the development of emotion dysregulation. The present longitudinal study aims to understand this complex interplay and analyzes emotion dysregulation as mediating variable for the relationship between parental warmth or strictness and aggressive behavior from preschool through elementary school. Additionally, parents’ educational level and their unity in parenting were considered as antecedent factors influencing parenting styles. The present path analyses are based on questionnaire data from 442 children and their families. The results show indirect effects for the associations between parenting style and aggressive behavior in preschool and elementary school via children’s emotion dysregulation. At the same time, a lower level of education and unity in parenting are more strongly associated with a strict parenting style. Children’s emotion dysregulation can be positively influenced by a warm and less strict parenting style, leading to a reduction in problems with aggressive behavior from preschool to elementary school.

The Mediating Role of Callous-Unemotional Traits in the Relationship between Parental Aggression and Behavioral Problems among Chinese Preschoolers.

It is well known that aggressive parenting is associated with behavioral problems among Western children in their early childhood, but this has rarely been examined among Chinese preschoolers. The purpose of this study is to explore the relationship between aggressive parenting, callous-unemotional traits (CU traits), and behavioral problems among a large Chinese preschool sample. Data were collected in Wuhu city, China, from 1879 preschoolers (54% of whom were male) with a mean age of 65.66 months (standard deviation = 9.41). Parents provided information about the frequency of aggressive parenting, children's behaviors, and demographic characteristics via an online questionnaire. Mediation models were applied to analyze the associations between aggressive parenting, CU traits, and behavioral problems. Preschoolers' age, gender, and family socioeconomic status were considered as covariates. The findings of our study revealed that higher frequencies of parental psychological and physical aggression were associated with high levels of CU traits, which were related to increased levels of preschoolers' behavioral problems. This study extends previous studies by revealing a positive relationship between aggressive parenting and behavioral problems among Chinese preschoolers via CU traits and highlights the risks of aggressive parenting. Interventions for improving parenting strategies and lessening callous-unemotional traits should be developed to help reduce behavioral problems.

Protective effect of parental monitoring on early-to-mid adolescents displaying high-level and increasing aggressive behavior

Studies that distinguish parental monitoring (parent-driven behaviors) from parental knowledge often fail to find protective effects of monitoring on adolescent behavior problems. To answer whether parental monitoring is more strongly associated with adolescent behavior problems among adolescents who may need it most, this study applied group-based trajectory modeling to change in early- to mid-adolescent aggressive behavior problems and examined associations between parental monitoring with different subgroups. Three latent groups of adolescents were found: Low Aggression, Medium-Increasing Aggression, and High-Increasing Aggression. Results show that more maternal and paternal monitoring were associated with fewer adolescent aggressive behavior problems only for adolescents in the High-Increasing Group. This result suggests that parental monitoring is a protective factor against adolescent aggressive behavior problems for subgroups of adolescents who may need it most and less impactful for other adolescents.

Hostile interpretation as a transdiagnostic factor for cooccurring anxiety in boys with aggressive behavior problems

AbstractMany children with aggressive behavior problems also suffer from anxiety. This cooccurrence may perhaps be explained by transdiagnostic factors. Identifying these factors seems crucial, as they may be important targets to treat these cooccurring problems effectively. This two‐study paper investigates whether hostile interpretation of others’ intentions is a transdiagnostic factor for cooccurring aggression and anxiety problems, examining two samples of boys in middle childhood. We assessed boys’ aggression and anxiety using teacher‐report in Study 1 (N = 84, Mage = 10.10), and parent‐report in Study 2 (N = 115, Mage = 10.55). In both studies, we assessed hostile interpretation using vignettes describing ambiguous provocations by peers. Both studies revealed a strong association between aggression and anxiety problems, underscoring the necessity to examine factors that can explain this cooccurrence. However, in neither study was this association reduced when we added hostile interpretation to the model, suggesting that hostile interpretation did not function as a transdiagnostic factor in our samples. One possible explanation for these findings is that hostile interpretation predicts both aggression and anxiety problems, but in different children. We, therefore, encourage scholars to conduct more research to explain the high comorbidity of aggression and anxiety problems in children. Future research should also examine hostile interpretation as predictor or transdiagnostic factor for aggression and anxiety problems in more diverse population, including girls and other age groups.

“I'm not here to push you:” raising adolescents' treatment engagement via autonomy support

More than 45% of adolescents with aggressive behavior problems drop out of treatment prematurely. Building on insights from self-determination theory, we examined in three studies whether clinicians can raise adolescents' treatment engagement by supporting their autonomy. In an interview study (Study 1), clinicians (N = 16; 43.8% female; ages 30–57) spontaneously described 12 times more autonomy-supportive than controlling strategies to engage adolescents. In a preregistered experiment (Study 2), clinicians (N = 68; 88.2% female; ages 23–65) were confronted with videos of adolescents displaying resistance. We manipulated the DSM diagnosis of adolescents to indicate either aggressive behavior problems or other problems. We found that, regardless of diagnosis, clinicians used both autonomy-supportive strategies (57.7% of responses) and controlling strategies (39.3%), suggesting that applying autonomy support can be challenging with any adolescent displaying resistance. In an experimental study (Study 3), adolescents (N = 252; 50.0% female; ages 12–17) reported higher therapeutic alliance (d = 0.95, 95% CI [0.80, 1.10]) and treatment engagement (d = 0.77, 95% CI [0.63, 0.91]) after listening to audio-recorded autonomy-supportive versus controlling responses from clinicians, regardless of whether these adolescents had aggressive behavior problems. Overall, this research suggests that clinicians can raise adolescents’ treatment engagement through autonomy support.

Association of behaviors and asthma control in a sample of Lebanese adolescents with asthma.

The relationship between behavioral problems and asthma is bidirectional; while the presence of a chronic disease such as asthma might predispose the person to stress, anxiety, and other behavioral issues, behavioral problems might in turn cause uncontrolled asthma through nonadherence to asthma management strategies. In Lebanon, behavioral problems and uncontrolled asthma could be of significant concern for adolescents. Consequently, we found it necessary to evaluate association between behavioral problems and uncontrolled asthma in a sample of Lebanese adolescents. Data for this cross-sectional study were collected using the snowball sampling technique in July 2023. The questionnaire was developed with Google Forms and distributed to participants via social media platforms and messaging applications. The Asthma Control Test (ACT) was used to check for uncontrolled asthma, and the Youth Self-Report (YSR) scale was used to assess behavioral problems. It yields nine subscales (anxious-depressed, withdrawn-depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, aggressive behavior, and other problems) and a total score. When taking each behavior score as an independent variable, older age was associated with lower ACT scores (more controlled asthma); F(15, 186) = 3.66, P = 0.014, and 95% Confidence Interval (CI) [-0.85, -0.10]. Living in a rural area, compared to urban was associated with higher ACT scores, P = 0.018, and 95% Confidence Interval (CI) [0.28, 2.94]. The intake of the COVID-19 vaccine, P = 0.003 and 95% CI [0.73, 3.55]; waterpipe smoking, P = 0.017 and 95% CI [0.38, 3.85]; and having more somatic complaints, P = 0.005 and 95% CI [0.04, 0.25], also were significantly associated with higher ACT scores (more uncontrolled asthma). When taking the total behavior score as an independent variable, higher YSR scores were associated with higher ACT scores (more uncontrolled asthma), F(10, 191) = 4.30, P = 0.038, and 95% CI [0.003, 0.10]. Our findings support the inclusion of mental health treatments for better asthma control and point to a link between behavioral issues and uncontrolled asthma. In a developing nation without a clear established strategy for asthma prevention, the findings of this study could help develop potentially beneficial public health treatments.

Behavioral and emotional problems and related risk factors of primary school children aged 6-11 in Guangdong, China.

China has seen rapid urbanization and industrialization in recent decades and children behavioral and emotional problems accompanied have been a heavy burden on family and society. We therefore aimed to estimate the prevalence and risk factors of behavioral and emotional problems in primary school children aged 6-11 in an urbanized area of China. Primary school children aged 6-11 from 15 primary schools were enrolled from Shunde District, Guangdong. The Child Behavior Checklist (CBCL) was used to assess behavioral and emotional problems and then determined risk factors associated with the behavioral and emotional problems. In total, 12 868 were included in the present analysis. The prevalence of total behavioral and emotional problems was 8.4% (95% CI, 7.9%-8.9%), which was gradually increased with age in both boys and girls. The prevalence was higher in boys than girls (9.8% vs. 6.8%, p < .001) and in children without siblings than those with siblings (9.9% vs. 8.1%, p=.006). In boys, age was positively associated with delinquent behavior, depression, poor contact, compulsive activity, social withdrawal, attention problems and aggressive behavior and was negatively associated with schizoid (p < .05). While in girls, age was positively associated with delinquent behavior, somatic complaints, social withdrawal and schizoid/compulsive activity but was negatively associated with aggressive behavior and sexual problems (p < .05). Behavioral and emotional problems are common in primary school children in the urbanized area of China and are associated with sex and siblings. These findings suggest that close attention should be given to these primary school children.

Child-therapist and parent-therapist alliances and outcome in the treatment of children with oppositional defiant/conduct disorder

Objective This study examined the quality of therapeutic alliance from different rater perspectives (child, parent, therapist) in cognitive behavioural therapy for children with oppositional defiant disorder (ODD) and conduct disorder (CD), and its association with symptom severity. Further, a panel model with an autoregressive cross-lagged panel design was used to explore whether therapist-rated and parent-rated therapeutic alliance influences change in symptom severity, or vice versa. Methods Sixty boys aged 6–12 years with a principal diagnosis of ODD/CD, and their parents, received individually delivered social competence training for childhood aggressive behaviour problems. Child, therapist, and parent ratings of therapeutic alliance and symptom severity were measured twice. Results Our results indicate good to very good therapeutic alliance that was relatively stable over time. The cross-sectional analyses of the alliance-symptom association revealed moderate correlations. However, effects of early alliance on later treatment outcome or of early symptom severity on later alliance were marginal. The only significant association was found between early parent-rated therapist-parent alliance and later parent-rated symptom severity. Conclusion Our study shows a moderate correlation between simultaneously assessed therapeutic alliance and symptoms. The findings of the panel model indicate that an early good therapeutic alliance is a component of later therapeutic success (parent perspective).

Increased behavioral problems in children with sleep-disordered breathing

BackgroundHealthy sleep is essential for the cognitive, behavioral and emotional development of children. Therefore, this study aimed to assess the behavioral consequences of sleep disturbances by examining children with sleep-disordered breathing compared with control participants.MethodsSeventy-eight children with SDB (average age: 6.7 years (SD = 1.83); 61 had OSA and 17 had primary snoring) and 156 control subjects (average age: 6.57 years (SD = 1.46) participated in the study. We matched the groups in age (t(232) = 0.578, p = 0.564) and gender (χ2(1) = 2.192, p = 0.139). In the SDB group, the average Apnea–Hypopnea Index was 3.44 event/h (SD = 4.00), the average desaturation level was 87.37% (SD = 6.91). Parent-report rating scales were used to measure the children’s daytime behavior including Attention Deficit Hyperactivity Disorder Rating Scale, Strengths and Difficulties Questionnaire, and Child Behavior Checklist.ResultsOur results showed that children with SDB exhibited a higher level of inattentiveness and hyperactive behavior. Furthermore, the SDB group demonstrated more internalizing (anxiety, depression, somatic complaints, social problems) (p < 0.001) and externalizing (aggressive and rule-breaking behavior) problems compared with children without SDB, irrespective of severity.ConclusionsBased on our findings we supposed that snoring and mild OSA had a risk for developing behavioral and emotional dysfunctions as much as moderate-severe OSA. Therefore, clinical research and practice need to focus more on the accurate assessment and treatment of sleep disturbances in childhood, particularly primary snoring, and mild obstructive sleep apnea.

Detecting social information processing profiles of boys with aggressive behavior problems: An interactive virtual reality approach

Children with aggressive behavior problems may aggress for different reasons, requiring tailored assessment and treatment. The aim of this study was to test whether it is possible to detect distinct social information processing (SIP) profiles among boys with aggressive behavior problems. We therefore conducted Latent Profile Analyses on boys' SIP patterns assessed in interactive virtual reality. Additionally, we examined the discriminant validity of these SIP profiles by comparing them on theoretically relevant child characteristics (i.e., temperament, executive functioning, aggressive belief systems, punishment insensitivity, sensation seeking). We presented boys (N = 181; ages 7-13) with a virtual classroom where they could play games with virtual peers. They reported on their SIP in four virtual reality scenarios, designed to assess reactive and proactive aggressive SIP. Results revealed four distinct SIP profiles: a general reactive SIP profile, a situation-specific reactive SIP profile, a mixed reactive-proactive SIP profile, and a nonaggressive SIP profile. Planned contrasts revealed that boys with these SIP profiles differed in temperament, aggressive belief systems, and punishment insensitivity, but not in executive functioning and sensation seeking. Overall, findings suggest that boys differ in the exact SIP patterns underlying their aggressive behavior, providing inroads to tailor interventions to children's individual needs.