Child Behavioral Difficulties Research Articles

Sleep Dysfunction and Behavioral Daytime Problems in Children with Autism Spectrum Disorders: A Comparative Study.

To compare parent reported sleep behaviors of children with Autism Spectrum Disorders (ASD) and normal healthy controls and to examine the association of sleep disturbances with daytime behavioral difficulties in children with ASD. Sixty ASD children (85% boys) (Mean age=6.1 y, SD=2.4) were recruited from the Psychology unit of the Department of Pediatrics of a tertiary care hospital. An age and socio-economic status matched group of typically developing (TD) children (N=60) were also recruited. The Children's Sleep Habits Questionnaire (CSHQ) was used to measure sleep problems. The Childhood Psychopathology Measurement Schedule was used to measure day time behavioral difficulties. Sleep problems were nearly two times more prevalent among children with ASD (88.3%) as compared to the TD group (46.7%) (χ2=23.74, P=0.0001). The total CSHQ and 6 out of the 8 subscales scores of the ASD group were also significantly higher than the TD group. Overall, children with ASD displayed significant more bedtime resistance than controls (t= 3.95, P=0.001). The sleep duration subscale showed that children with ASD, relative to the TD group, slept too little (χ2=23.08, P=0.0001), did not sleep the right amount of time (χ2= 11.86, P=0.003), and displayed significant variation in the duration of time slept (χ2=11.96, P=0.003). In addition, parent reported sleep dysfunction had a significant relationship with daytime reported behavior difficulties (r=0.53, P=0.01) in children with ASD. Stepwise multiple regression analysis revealed that 30% of the variance in number of daytime behavioral problems was explained by only two variables: total CSHQ scores and duration of night awake time (F=11.18, P=0.001). Children with ASD are at a high risk for sleep problems and this is associated with daytime behavior disturbances. Pediatricians should routinely screen ASD children for sleep problems and initiate timely and appropriate interventions.

Antenatal and Postnatal Determinants of Behavioural Difficulties in Early Childhood: Evidence from Growing Up in New Zealand.

Behavioural difficulties during early childhood have significant implications for multiple outcomes later in life. Child behavioural difficulties at 2years of age (N = 6246) were assessed by mothers enrolled in a longitudinal, population-based New Zealand cohort study. 10.1% of children had total difficulties scores in the abnormal range on the preschool version of the Strengths and Difficulties Questionnaire. After controlling for maternal education, poverty, and child's birth age/weight, several antenatal and postnatal maternal health and family risk factors were significant for: (i) emotional problems (antenatal maternal perceived stress, lack of periconceptional folate, and moderate to severe maternal postnatal anxiety); (ii) hyperactivity-inattention (antenatal maternalperceived stress,mothers' antenatal exposure to secondhand smoke, moderate to severe maternal postnatal anxiety, and low maternal self-evaluation); (iii) conduct problems and total difficulties (antenatal maternal perceived stress, verbal inter-parental conflict and low maternal self-evaluation). The identification of risk and protective factors associated with early childhood difficulties are vital for guiding intervention and prevention efforts.

Childhood aggression and the co-occurrence of behavioural and emotional problems: results across ages 3\u201316\xa0years from multiple raters in six cohorts in the EU-ACTION project

Childhood aggression and its resulting consequences inflict a huge burden on affected children, their relatives, teachers, peers and society as a whole. Aggression during childhood rarely occurs in isolation and is correlated with other symptoms of childhood psychopathology. In this paper, we aim to describe and improve the understanding of the co-occurrence of aggression with other forms of childhood psychopathology. We focus on the co-occurrence of aggression and other childhood behavioural and emotional problems, including other externalising problems, attention problems and anxiety–depression. The data were brought together within the EU-ACTION (Aggression in Children: unravelling gene-environment interplay to inform Treatment and InterventiON strategies) project. We analysed the co-occurrence of aggression and other childhood behavioural and emotional problems as a function of the child’s age (ages 3 through 16 years), gender, the person rating the behaviour (father, mother or self) and assessment instrument. The data came from six large population-based European cohort studies from the Netherlands (2x), the UK, Finland and Sweden (2x). Multiple assessment instruments, including the Child Behaviour Checklist (CBCL), the Strengths and Difficulties Questionnaire (SDQ) and Multidimensional Peer Nomination Inventory (MPNI), were used. There was a good representation of boys and girls in each age category, with data for 30,523 3- to 4-year-olds (49.5% boys), 20,958 5- to 6-year-olds (49.6% boys), 18,291 7- to 8-year-olds (49.0% boys), 27,218 9- to 10-year-olds (49.4% boys), 18,543 12- to 13-year-olds (48.9% boys) and 10,088 15- to 16-year-olds (46.6% boys). We replicated the well-established gender differences in average aggression scores at most ages for parental ratings. The gender differences decreased with age and were not present for self-reports. Aggression co-occurred with the majority of other behavioural and social problems, from both externalising and internalising domains. At each age, the co-occurrence was particularly prevalent for aggression and oppositional and ADHD-related problems, with correlations of around 0.5 in general. Aggression also showed substantial associations with anxiety–depression and other internalizing symptoms (correlations around 0.4). Co-occurrence for self-reported problems was somewhat higher than for parental reports, but we found neither rater differences, nor differences across assessment instruments in co-occurrence patterns. There were large similarities in co-occurrence patterns across the different European countries. Finally, co-occurrence was generally stable across age and sex, and if any change was observed, it indicated stronger correlations when children grew older. We present an online tool to visualise these associations as a function of rater, gender, instrument and cohort. In addition, we present a description of the full EU-ACTION projects, its first results and the future perspectives.

Application of a Multitrait-Multimethod Matrix to Social, Emotional, and Behavioral Screening

ABSTRACTThe authors' purpose was to evaluate the multiple-gate Preschool Behavior Screening System (PBSS) for identifying children's social, emotional, and behavioral (SEB) difficulties. The sample included 122 triads of preschool children between 3 and 5 years old and their parents and teachers. The teacher and parent samples were predominantly women and European American with a substantial African American representation. The design involved numerous indicators of the reliability of scores and the validity of ensuing inferences. Scores from the Behavior Assessment System for Children, Second Edition were used as criterion measures for scores from the PBSS. The PBSS scores were found reliable across scales with Cronbach's alpha values ranging from.85 to.97. Agreement between teachers and parents was consistent with findings from previous research. Analyzed within a Multitrait-Multimethod Matrix, correlational evidence supported inferences about externalizing difficulties, prosocial behavior, and total problems, as well as internalizing difficulties to a lesser degree. Receiver-operating characteristic curve analyses supported the PBSS across a range of scales and cut scores. Findings support the use of the PBSS as one method for identifying preschool children who may be at risk for SEB difficulties and underscore the importance of using multiple informants in the assessment of SEB difficulties.

Accelerated long-term forgetting and behavioural difficulties in children with epilepsy

Patients with epilepsy have been shown to exhibit a range of memory deficits, including the rapid forgetting of newly-learned material over long, but not short, delays (termed accelerated long-term forgetting; ALF). Behavioural problems, such as mood disorders and social difficulties, are also overrepresented among children with epilepsy, when compared to patients with other chronic diseases and the general population. We investigated whether ALF was associated with behavioural or psychosocial deficits in children with epilepsy. Patients with either idiopathic generalised epilepsy (IGE; n = 20) or temporal lobe epilepsy (TLE; n = 23) and healthy controls (n = 53) of comparable age, sex, and socioeconomic status completed a battery of neuropsychological tests, including a list-learning task that required recall after short (30-min) and long (7-day) delays. Parents or guardians of all participants also completed the Child Behavior Checklist (CBCL). Compared to control participants, patients with IGE and TLE had higher scores on all but one of the indices of behavioural problems. When patients with IGE and TLE were merged into a single group, they were found to have negative correlations between 7-day recall and internalising, social and total problem behaviour domains, where poorer 7-day recall was associated with behavioural problems of greater severity. These findings suggest that impaired episodic recall is associated with behavioural deficits, including social problems, which are routinely observed in patients with epilepsy.

An evaluation of play therapy for children and young people with intellectual disabilities

ABSTRACTChildren and young people with intellectual disabilities are more likely to experience emotional, behavioural, or mental health difficulties, including a combination of these health problems. There are risks that existing interventions may not be accessible or effective for this group. This program evaluation explored the effectiveness of child-centred play therapy, a developmentally appropriate mental health intervention, for a single group of 42 children with intellectual disabilities aged 4 to 16 years with emotional, behavioural, or mental health difficulties. The intervention was provided by seven therapists trained in the same play therapy protocol and procedures. Parents rated children's emotional and behavioural difficulties before and after play therapy using the Strengths and Difficulties Questionnaire. Statistically significant improvement to children's prosocial skills, emotional and behavioural difficulties, and the impact of these difficulties on everyday life was found at the completion of child-centred play therapy. Children with high-priority referral needs were found to have made greater levels of change. However, with increasing severity of difficulties, children required more time in therapy. A higher level of play therapy training predicted greater prosocial skill development for children and a reduced impact of difficulties on their daily life. This evaluation demonstrated that play therapy may be an effective intervention to use with children with intellectual disabilities and emotional and behavioural difficulties, and warrants further consideration for research and practice by the disability and mental health sectors.

Adoptive parents' evaluation of expectations and children's behavior problems: The mediational role of parenting stress and parental satisfaction

Despite empirical evidence of the impact of parents' expectations on the success of adoption, few studies have specifically focused on this subject. This study aimed to test the impact of parents' evaluation of expectations on their child's behavioral problem by investigating a sequential mediation effect of parenting stress and parental satisfaction. The sample included 116 adoptive parents (31–60 years) of children (6–12 years) who had been part of the family for, at least, two years. The Portuguese versions of the Parenting Stress Index-Short Form and the Strengths and Difficulties Questionnaire-Parents version were used to measure the level of parenting stress and the children's behavioral difficulties, respectively. Moreover, specific indexes of parents' evaluation of expectations and satisfaction were used. The results supported the sequential mediation model proposed, highlighting the importance of fostering the development of accurate expectations.

Integrating a public health and human rights approach into mental health services for Palestinians in the Gaza Strip

BackgroundIn the context of violations of human rights and insecurity, the Gaza Community Mental Health Programme (GCMHP) provides mental health services and psychosocial interventions that match local cultural and social norms. The GCMHP uses a community mental health approach to promote the psychological wellbeing of the people living in the Gaza Strip and advocate on mental health issues. MethodsThe GCMHP provides preventive and therapeutic care to a broad public health spectrum of Gazan society. Services are provided in terms of preventative public health at the primary, secondary, and tertiary levels. Data reported here are from 2014–16. FindingsFor primary prevention, our services include advocacy, public awareness, and media campaigns aimed at raising awareness about and preventing common mental disorders and behavioural difficulties in children. 35 878 people are estimated to have benefited from these programmes. The GCMHP also provides psychological first aid and crisis intervention to vulnerable persons and a free telephone counselling service. About 12 943 persons have received individual sessions, and 2590 persons have received telephone counselling. The GCMHP also provides training to enhance the skills of professionals of local organisations working in mental health and psychosocial services. 3557 people have attended these programmes. As secondary prevention, the GCMHP offers individual and group psychotherapy, and routine home visits are provided for torture survivors and individuals and families exposed to cumulative trauma. 11 713 individuals have received such services. As tertiary prevention, rehabilitation services including physiotherapy and occupational therapy are provided to help patients regain their role as active members of the community. 398 people have received these services. InterpretationA public health-oriented approach to mental health services fits the socioecological model that locates individuals and families within the context of their community, religious-cultural context, and social, economic, and political systems. With social responsibility embedded as a core value, the GCMHP seeks to restore psychological wellbeing in citizens of the Gaza Strip. FundingNone.

Parent–Child Discordance and Child Trauma Symptomatology Throughout Therapy: Correlates and Treatment Response

Children and their caregivers often disagree when reporting on child behavioural and emotional difficulties. But how does parent–child discordance relate to outcomes, particularly among children undergoing trauma therapy? This study examined parent–child discordance in relation to children’s trauma symptoms and therapy outcomes. Participants included 96 trauma-exposed children and their caregivers, who received Trauma-Focused Cognitive Behavioural Therapy. Discordance was calculated using absolute difference scores between child- and parent- reported psychological symptoms. Parent–child discordance, calculated at pre-therapy, post-therapy, and at a six-month follow-up, predicted the severity of children’s posttraumatic stress, dissociation, and internalizing and externalizing difficulties at each respective time-point. Pre-therapy discordance predicted improvements in externalizing behaviours after therapy and at follow-up. Improvements in discordance predicted improvements in trauma-specific symptoms over the course of treatment and at follow-up. The findings underscore how changes in parent–child discordance are related to child trauma symptoms and treatment response. Clinical implications and future directions are discussed.

Parenting a Child with Phenylketonuria: AnInvestigation into the Factors That Contribute toParental Distress.

Phenylketonuria (PKU) is an inherited metabolic condition that can lead to the onset of intellectual disabilities if not strictly managed through a low-protein diet. Parents are responsible for supervising their child's treatment for PKU, which may impact on their experience of distress. This cross-sectional study aimed to identify the factors that contribute to distress in parents who care for a child with PKU, distinct from parents in the general population. Thirty-eight parents of children and adolescents with PKU and 32 parents in the general population completed the questionnaires measuring parental psychological resilience, child behaviour problems, perceived social support and distress. Parents of children with PKU also completed measures of their child's care dependency and behaviour related to developmental and intellectual disabilities. The findings revealed no statistically significant differences in distress between the groups, but parents of children with PKU reported more child behaviour problems. Multiple regression analysis identified that parental psychological resilience and child anxious behaviour explained 35% of the variance in distress for parents of children with PKU. By comparison, parental psychological resilience and generic child behaviour only accounted for 19% of the variance in distress for parents in the general population. This has implications for developing interventions in clinical settings that aim to reduce parents' distress by enhancing their psychological resilience and supporting them to manage child behaviour difficulties, particularly anxious behaviour. Future research should include larger, more diverse samples and use longitudinal study designs.

Bidirectional Associations Between Child Sleep Problems and Internalizing and Externalizing Difficulties From Preschool to Early Adolescence

Although multiple cross-sectional and longitudinal studies have established that sleep problems and behavioral difficulties are associated in children, the directionality of this association and whether sleep problems are differentially associated with different types of childhood behavioral difficulties are unclear. Understanding these associations will inform the focus and timing of interventions. To determine whether longitudinal and reciprocal associations exist between child sleep problems and externalizing, internalizing, or both behavioral difficulties. Prospective cohort study using nationally representative data from the first 5 waves (2004, 2006, 2008, 2010, and 2012) of the kindergarten cohort (4983 children aged 4-5 years in 2004) collected for the Longitudinal Study of Australian Children. Associations were evaluated using cross-lagged structural equation model analyses performed from May 25, 2016, to September 20, 2017. Child sleep problems and internalizing and externalizing behavioral difficulties. Sleep problems were defined using parent-reported child sleep problem severity and specific difficulties (ie, difficulty getting to sleep at night, not happy sleeping alone, waking during the night, and restless sleep) on 4 or more nights of the week. Child behavioral difficulties were defined using the parent-reported Strengths and Difficulties Questionnaire for externalizing difficulties (conduct problems and hyperactivity/inattention subscales) and internalizing difficulties (emotional problems subscale). The 4983 children enrolled in 2004 had a mean (SD) age of 4.7 (0.2) years and comprised a similar percentage of boys (2536 [50.9%]) and girls. In 2012, 3956 children (79.4%) aged 12 to 13 years were retained. Significant bidirectional associations were detected between sleep problems and externalizing difficulties during the elementary school transition period, with greater sleep problems associated with later externalizing behavior and vice versa (cross-lagged path coefficient, 0.04 [95% CI, 0.01-0.08] to 0.09 [95% CI, 0.06-0.13]). Although sleep was a significant driver of later internalizing difficulties (coefficient, 0.10 [95% CI, 0.07-0.14] to 0.16 [95% CI, 0.12-0.19]), the reverse association was not significant. In the final model that included all 3 constructs, the associations were attenuated but remained significant over time. These results suggest that future studies should investigate whether implementing sleep problem intervention decreases the occurrence of both externalizing and internalizing difficulties. Interventions targeting externalizing, but not internalizing, difficulties may benefit childhood sleep.

The Association Between Child and Family Characteristics and the Mental Health and Wellbeing of Caregivers of Children with Autism in Mid-Childhood

We examined predictors of mental health difficulties and wellbeing in caregivers of children with autism in the Pre-school Autism Communication Trial cohort in middle childhood (N = 104). Child’s intellectual disability, daily living skills impairment, elevated emotional and behavioural difficulties, high educational level of caregiver and household income below the median significantly predicted caregivers’ mental health difficulties, but autism severity, child communication skills and family circumstances did not. Lower caregiver mental wellbeing was predicted by elevated child emotional and behavioural difficulties. The need to support the mental health and wellbeing of caregivers of children with autism is discussed in light of the results.

Psychosocial and Executive Function Recovery Trajectories One Year after Pediatric Traumatic Brain Injury: The Influence of Age and Injury Severity.

Time since traumatic brain injury (TBI) and developmental stage at injury may affect the trajectory of outcomes associated with adjustment and school success. We prospectively enrolled a cohort of 519 children with either TBI or orthopedic injury (OI) age 2.5-15 years to examine children's psychosocial and executive function outcomes at 3- and 12-months post-injury. Outcome measures included the Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire (SDQ), and Behavior Rating Inventory of Executive Function (BRIEF) ratings. Controlling for pre-injury ratings and using the OI group as the reference, children with TBI, regardless of age or injury severity, had affective, anxiety, and attention-deficit/hyperactivity disorder (ADHD) problems on the CBCL. Symptom trajectories differed both by injury severity and age at injury. Children with mild and complicated mild TBI had a decreasing anxiety trajectory, whereas children with severe TBI had increasing symptoms. Children 6-11 years of age had high ADHD and affective scores; however, the youngest children had increasing symptoms over time. On the SDQ, peer relationships and prosocial behaviors were not significantly affected by TBI but were associated with family environment. Children with severe TBI had the worst executive function scores; however, mild and complicated mild/moderate TBI groups had clinically important working memory deficits. Hispanic ethnicity and strong social capital were positively associated with multiple outcomes. Children's recovery trajectories differed by injury severity, time since injury, and developmental stage when injured. Schools need to reassess children's skills over time as new problems in behavior and learning may emerge.

Family Involvement in School-Based Behavioral Screening: A Review of Six School Psychology Journals from 2004 to 2014

Universal behavioral screening in the school setting plays a vital role in the prevention and early intervention of child difficulties. While universal screening methods have evolved, measures appear to examine child characteristics based on data collected primarily from teachers and children. Parents may also have important information to contribute to screening efforts; however, the extent to which parents are regularly involved in the screening process is somewhat unknown. This study investigated the behavioral screening literature in major school psychology journals from 2004 to 2014 to determine the frequency to which families and caregivers participate in the screening of child behavioral difficulties in schools. Results indicated very few research articles utilized families as screening informants. In addition, the majority of articles either did not mention families directly or only mentioned families briefly throughout the study. Implications for the inclusion of families within the screening process are discussed.

Mind-mindedness in parents of looked-after children.

The studies reported here aimed to test the proposal that mind-mindedness is a quality of personal relationships by assessing mind-mindedness in caregiver-child dyads in which the relationship has not spanned the child's life or in which the relationship has been judged dysfunctional. Studies 1 and 2 investigated differences in mind-mindedness between adoptive parents (ns = 89, 36) and biological parents from the general population (ns = 54, 114). Both studies found lower mind-mindedness in adoptive compared with biological parents. The results of Study 2 showed that this group difference was independent of parental mental health and could not fully be explained in terms of children's behavioral difficulties. Study 3 investigated differences in mind-mindedness in foster carers (n = 122), parents whose children had been the subject of a child protection plan (n = 172), and a community sample of biological parents (n = 128). The level of mind-mindedness in foster carers and parents who were involved with child protection services was identical and lower than that in the community sample; children's behavioral difficulties could not account for the difference between the 2 groups of biological parents. In all 3 studies, nonbiological carers' tendency to describe their children with reference to preadoption or placement experiences was negatively related to mind-mindedness. These findings are in line with mind-mindedness being a relational construct. (PsycINFO Database Record

Parental Perceptions and Child Emotional and Behavioral Problems in Autism.

Emotional and behavioral difficulties in children with autism often present problems for families seeking appropriate treatment interventions. Using data from the 2011 Survey of Pathways to Diagnosis and Services, ordinal logistic regression models were used to examine the association between parental perceptions about autism and their reports of child emotional and behavioral problems. Results showed that parents who attributed their child's autism to environmental factors, experienced emotional upset or confusion about autism, or perceived the condition to be pervasive or burdensome, were more likely to reported clinically significant emotional and behavioral difficulties. Findings suggest that support services must consider parent perceptions when developing interventions to assist with children's emotional and behavioral challenges. Implications for practice and research are discussed.

Accounting for the impact of parent internalizing symptoms on Parent Training benefits: The role of positive parenting

Parent Training (PT) is not as effective for parents with histories of internalizing symptoms as it is for other parents. This study aimed to determine which dimensions of parenting, notably parenting efficacy, positive parenting, inconsistent discipline, and poor supervision, mediate the association between parent lifetime internalizing symptoms and post-PT child emotional and behavioral difficulties. One hundred fourteen parents (82% biological mothers) of children aged 9–12 years received PT at an urban children's mental health clinic. Parents reported their lifetime internalizing symptoms, pre- and post- PT parenting skills, and pre- and post- PT child difficulties. Positive parenting fully mediated the relation between parent lifetime internalizing symptoms and elevated child post-PT emotional and behavioral difficulties. Specifically, parents higher in internalizing symptoms reported lower positive parenting post-PT, which in turn predicted more child difficulties post-PT. Findings suggest that fostering positive parenting in PT may be particularly important for parents with histories of internalizing symptoms.

Variable learning disability and behavioural difficulties in children with familial hypocalciuric hypercalcaemia type 3

Variable learning disability and behavioural difficulties in children with familial hypocalciuric hypercalcaemia type 3

Child-care quality moderates the association between maternal depression and children's behavioural outcome.

Maternal depression is a risk factor for adverse outcomes in the child, including emotional and behavioural difficulties. There is evidence that child care attendance during the preschool years may moderate associations between familial risk factors and child outcome. However, the possibility that high-quality child care provides protection for children exposed to maternal depression or that low-quality child care provides additional riskhas not been investigated. We study whether child-care quality moderates the association between probable history of maternal depression (PMD) and child behavioural and emotional outcomes over the preschool period. Within a longitudinal study, we examined PMD (no depression; clinical PMD before the child's birth; subclinical PMD from 0 to 5years; clinical PMD from 0 to 5years), child-care quality and child emotional and behavioural difficulties at the ages of 2, 3 and 4years. Child-care quality was evaluated in settings, and trajectories were calculated to reflect (a) global quality and (b) two quality subfactors: 'Teaching and interactions' and 'Provision for learning'. Data were analysed for 264 families. Significant interactions emerged between clinical PMD and global quality of child care for children's externalising behaviour (b=-.185, p=.008), more specifically hyperactivity/inattention (b=-.237, p=.002). In the context of clinical PMD, children attending high-quality child care presented fewer difficulties than those attending a low-quality care. Child-care quality was not associated with outcomes for children whose mothers did not report a PMD or a PMD before their birth. In the context of PMD, high-quality child care was associated with fewer behavioural problems and may thus constitute a protective factor.

Effects of Maternal Depression Symptoms and Alcohol Use Problems on Child Internalizing and Externalizing Behavior Problems

Empirical evidence suggests maternal behavioral health problems are significant predictors of child behavioral health difficulties, but it is unclear of the specific relation of maternal alcohol use problems and depression symptoms with child internalizing and externalizing behavior problems. The purpose of the study is to examine the impact of maternal depression symptoms and alcohol use problems on children’s internalizing and externalizing behavior problems over a period of 5 years. Implications for intervention may differ depending on which type of maternal behavioral health concerns predicts which child behavior problem. A total of 1874 families eligible for Early Head Start participated. Maternal depression symptoms and alcohol use problems were assessed when children were in preschool, and internalizing and externalizing behavior problems were assessed when children were in fifth grade. Clinical internalizing behavior problems was best predicted by maternal depression symptoms, whereas clinical externalizing behavior problems was best predicted by maternal alcohol use problems. Children were almost twice as likely to have clinical internalizing behavior problems when mothers exhibited very elevated depression symptoms compared to when mothers displayed minimal symptoms. A similar relation was found with maternal alcohol use problems and clinical externalizing behavior problems. Our findings highlight the importance of understanding and treating various kinds of behavioral health concerns in mothers of young children.