Child Behaviour Problems Research Articles

More than Mental Health: Parent Physical Health and Early Childhood Behavior Problems.

Caring for young children is a physically demanding task, and some evidence suggests parental physical limitations may impact the parent-child relationship and child behavioral development, but research examining this dynamic is nascent. This study aims to explicate the role of general parent physical health problems in child disruptive behavior outcomes. A model that included physical and mental health, parenting style and self-efficacy, and child behavior symptom ratings was derived. The tenability of the model was assessed using Pearson's correlations, followed by structural equation modeling using data from 375 parents with a child between 18 months and 5 years. After several modifications to the initial model, findings revealed that higher levels of parent self-reported physical and mental health concerns indirectly influence child behavior symptoms through different pathways. Impaired parent physical health was associated with poorer parental self-efficacy and more disruptive child behavior, whereas increased parent mental health concerns were associated with a more negative parenting style and lower self-efficacy, which was related to more child behavior symptoms. Findings elucidate the need for increased awareness and screening of parent physical health limitations in pediatric primary care. Furthermore, appropriate interventions among parents with physical health problems may target different aspects of parenting than routinely discussed.

ParentWorks: Evaluation of an Online, Father-Inclusive, Universal Parenting Intervention to Reduce Child Conduct Problems

Evidence-based parenting interventions are effective in reducing conduct problems, yet these interventions have limited reach, and few involve the participation of fathers. This paper describes the outcomes of an open trial of ParentWorks, a universal, online, father-inclusive parenting intervention aiming to decrease childhood behavioural problems and promote positive parenting in mothers and fathers. A total of 388 families (456 individual parents; 36.6% fathers) were included in the study. Mixed model analyses showed significant decreases in child emotional/behavioural problems, dysfunctional parenting, interparental conflict, and parental mental health problems. The baseline severity of child behavioural problems significantly moderated the effects on child outcomes so that children with higher levels of problems benefitted more from the program. Participation of both caregivers in two-parent families, as well as parent sex, did not significantly affect the program outcomes. Results provide initial empirical support for the universal, self-directed, online parenting intervention, in addressing both child behavioural problems and parenting outcomes. Trial registration: ACTRN12616001223426, registered 05/09/2016.

Prenatal risk factors for internalizing and externalizing problems in childhood.

A growing body of research has documented the effects of prenatal risk factors on a wide spectrum of adverse offspring health outcomes. Childhood behavior problems, such as externalizing and internalizing problems, are no exception. This comprehensive literature review aims to summarize and synthesize current research about commonly experienced prenatal risk factors associated with internalizing and externalizing problems, with a focus on their impact during childhood and adolescence. Potential mechanisms as well as implications are also outlined. The EBSCO, Web of Science, PubMed, Google Scholar, and Scopus databases were searched for studies examining the association between prenatal risk factors and offspring internalizing/externalizing problems, using keywords "prenatal" or "perinatal" or "birth complications" in combination with "internalizing" or "externalizing". Relevant articles, including experimental research, systematic reviews, meta-analyses, cross-sectional and longitudinal cohort studies, and theoretical literature, were reviewed and synthesized to form the basis of this integrative review. Prenatal risk factors that have been widely investigated with regards to offspring internalizing and externalizing problems encompass health-related risk factors, including maternal overweight/obesity, substance use/abuse, environmental toxicant exposure, maternal infection/inflammation, as well as psychosocial risk factors, including intimate partner violence, and anxiety/depression. Collectively, both epidemiological and experimental studies support the adverse associations between these prenatal factors and increased risk of emotional/behavioral problem development during childhood and beyond. Potential mechanisms of action underlying these associations include hormonal and immune system alterations. Implications include prenatal education, screening, and intervention strategies. Prenatal risk factors are associated with a constellation of offspring internalizing and externalizing problems. Identifying these risk factors and understanding potential mechanisms will help to develop effective, evidence-based prevention, and intervention strategies.

The p factor: genetic analyses support a general dimension of psychopathology in childhood and adolescence.

BackgroundDiverse behaviour problems in childhood correlate phenotypically, suggesting a general dimension of psychopathology that has been called the p factor. The shared genetic architecture between childhood psychopathology traits also supports a genetic p. This study systematically investigates the manifestation of this common dimension across self‐, parent‐ and teacher‐rated measures in childhood and adolescence.MethodsThe sample included 7,026 twin pairs from the Twins Early Development Study (TEDS). First, we employed multivariate twin models to estimate common genetic and environmental influences on p based on diverse measures of behaviour problems rated by children, parents and teachers at ages 7, 9, 12 and 16 (depressive traits, emotional problems, peer problems, autism traits, hyperactivity, antisocial behaviour, conduct problems and psychopathic tendencies). Second, to assess the stability of genetic and environmental influences on p across time, we conducted longitudinal twin modelling of the first phenotypic principal components of childhood psychopathological measures across each of the four ages. Third, we created a genetic p factor in 7,026 unrelated genotyped individuals based on eight polygenic scores for psychiatric disorders to estimate how a general polygenic predisposition to mostly adult psychiatric disorders relates to childhood p.ResultsBehaviour problems were consistently correlated phenotypically and genetically across ages and raters. The p factor is substantially heritable (50%–60%) and manifests consistently across diverse ages and raters. However, residual variation in the common factor models indicates unique contributions as well. Genetic correlations of p components across childhood and adolescence suggest stability over time (49%–78%). A polygenic general psychopathology factor derived from studies of psychiatric disorders consistently predicted a general phenotypic p factor across development (0.3%–0.9%).ConclusionsDiverse forms of psychopathology generally load on a common p factor, which is highly heritable. There are substantial genetic influences on the stability of p across childhood. Our analyses indicate genetic overlap between general risk for psychiatric disorders in adulthood and p in childhood, even as young as age 7. The p factor has far‐reaching implications for genomic research and, eventually, for diagnosis and treatment of behaviour problems.

Understanding the Externalizing Behavior of School-Age Boys: The Role of a Mother\u2019s Mentalization and Attachment

ObjectivesExternalizing behavior problems are considered to be a serious impediment to a child’s development, and therefore it is important to identify their predictors. In this study, we investigated the connections between school-aged boys’ externalizing problems, the mother’s reflective functioning (RF) and the mother’s perception of her childhood relationship with her own caregivers.MethodsThe study sample comprised 39 school-age boys diagnosed with externalizing behavior problems together with their mothers. A child’s psychopathology was assessed using the Child Behavior Checklist and Teacher Report Form. Our assessment of the mothers’ mentalizing capacities was based on the Adult Attachment Interview and Reflective Functioning Scale. The perception of a mother’s childhood relationship with her parents was assessed using the Parental Bonding Instrument.ResultsThe analysis revealed that more severe cases of aggressive and rule-breaking behavior in boys were associated with lower RF in mothers, as well as with a mother’s perception of her childhood relationship with her own parents as less autonomous. More aggressive behavior in boys was also associated with a mother’s perception of herself as experiencing a higher degree of care from her father during her own childhood.ConclusionsThese are only preliminary findings and we have discussed them with a view to understanding the possible ways in which a mother’s RF and the intergenerational context of relationship quality are associated with externalizing behavior problems in middle childhood.

Anger Expression, Emotion Regulation and Mindfulness as Predictors of Conduct Problems in Children

Conduct problems and aggressive behaviors of children are serious problems for peers, parents and teachers of these children. To improve the understanding of conduct problems the present study investigates the links between difficulties in anger expression, emotion regulation, difficulties in impulse control and conduct problems. Moreover the relation of mindfulness and emotion regulation was of interest in the present study. To answer our research questions 310 elementary school children (157 boys, 153 girls) and their parents reported anger expression, emotion regulation strategies, mindfulness and conduct problems in a questionnaire. The results revealed that mindfulness was significantly related to anger expression and conduct problems. Moreover a regression analysis showed that anger expression mediated the relation of mindfulness and conduct problems. Child and parent reports were only weakly related if anger expression strategies that are hardly observable (Anger In, Anger Control) were considered. Relations were somewhat stronger for Anger Out. The findings are discussed and the relevance of mindfulness based emotion regulation is highlighted. The findings support the assumption that mindfulness, anger expression and emotion regulation are important aspects that influence child behavior.

Caregiver and family quality of life for children with fetal alcohol spectrum disorder

BackgroundFetal alcohol spectrum disorder (FASD) is a common neurodevelopmental condition. Given that individuals with FASD can experience lifelong challenges, one field of research that could be applicable is the paediatric chronic health literature. AimsThe aim of the current study was to investigate the utility of the Pediatric Quality of Life Inventory (PedsQL) Family Impact Module, designed to measure the impact of paediatric chronic health conditions on caregivers and families. Methods and procedures109 caregivers of children with FASD completed an online survey that assessed a range of areas including, caregiver and family quality of life, caregiver mental health and child behaviour. Outcomes and resultsOverall, caregivers reported the areas most impacted on the PedsQL module were Family Daily Activities and Worry. Caregiver’s country of residence, mental health, child gender, and level of child behaviour problems were found to be predictors of caregiver and family quality of life. Conclusions and implicationsThe results demonstrate that there are multidimensional challenges for caregivers and families. These findings have important implications for policy and practice regarding the provision of supports and services for children with FASD and their families.

Impact of Parenting a Child with Cerebral Palsy on the Quality of Life of Parents: A Systematic Review of Literature

Purpose: The implications of parenting a child with cerebral palsy (CP) are multifaceted, as parents have to cope with their child’s functional limitations and specific needs, and prepare for the possibility of long-term dependence. There has been significant research on the consequences of managing these parenting tasks. This article reviews the literature on the effects of parenting children with CP, and summarises the related factors. Methods: A systematic search of online databases was conducted and, based on the reference lists of selected articles, further studies were identified. Thirty-six articles that met the inclusion criteria were analysed. Conclusion & Implication: Parents of children with CP were found to have lower quality of life, associated with high levels of stress and depression, due to factors such as child behaviour and cognitive problems, low caregiver self-efficacy and low social support. The implications of these findings in relation to the planning and development of interventions addressing the family as a whole are discussed. The aim is to enhance parents’ competence and resources so that they are better able to cope with the demands of parenting their children.

Behavior Problems in Physically Ill Children in Rwanda.

ABSTRACT:Objectives:Childhood behavior problems are underidentified in low- and middle-income countries. This study sought to systematically screen for behavior problems among children receiving medical care in Rwanda and investigate factors associated with behavior problems in this cohort.Methods:The Pediatric Symptom Checklist (PSC) was translated into Kinyarwanda, following best practices. Children aged 5.9 to 16 years admitted to the inpatient ward of a referral hospital or seen in the outpatient department (OPD) were screened using the PSC. All PSC-positive children and every third PSC-negative child were referred for definitive assessment by a child mental health specialist.Results:Among 300 eligible children, 235 were recruited; none refused. PSC scores were positive in 74 of 234 cases (32%, 95% confidence interval 26%–38%); a total of 28 of 74 (40%) PSC-positive children completed mental health assessments. Of these, 16 (57% of those assessed, and 7% of the 235 who were screened) required treatment or further assessment; none of the PSC-negative children did. Screening sensitivity was 100%, and specificity was 71%, with favorable receiver operating characteristics curve and internal consistency. In a multivariate analysis, higher PSC scores were associated with OPD care, central nervous system trauma or infection, and indices of malnutrition and with the use of traditional, complementary, and alternative medicine (TCAM).Conclusion:Behavior problems are common among Rwanda children seen in a referral hospital, particularly in the OPD, and are associated with use of TCAM. The Kinyarwanda PSC showed favorable screening characteristics and resulted in some 7% of children accessing needed mental health care.

Harsh Parenting and Black Boys' Behavior Problems: Single Mothers' Parenting Stress and Nonresident Fathers' Involvement

ObjectiveTo test a model linking economic hardship, parenting stress, and nonresident fathers' involvement in single mothers' family life during Black boys' early childhood (3–5 years of age) to harsh parenting and behavior problems in middle childhood (9 years of age).BackgroundParenting stress among single mothers heading low‐income Black families is poorly understood. Most of the research on the effects of stress in the parenting role and outcomes for mothers and children has focused on middle‐class White samples. Boys are of primary interest in this article because of evidence, based largely on studies of economically disadvantaged, two‐parent, White families, that boys may be more negatively affected than girls by aspects of family conflict that include harsh and coercive parenting.MethodUsing data from a subsample of unmarried Black mothers and nonresident biological fathers with a 3‐year‐old son (n = 748) from the Fragile Families and Child Wellbeing Study, a nationally representative data set, and survey interviews with mothers when the children were 3, 5, and 9 years of age, we examined relationships between and among mothers' economic hardship, depressive symptoms, parenting stress, father involvement, harsh parenting, and child behavior problems when the children were 3, 5, and 9 years of age. Latent variable structural equation modeling and effect decomposition were estimated.ResultsEconomic hardship was linked indirectly to harsh parenting through mothers' depressive symptoms and parenting stress, both of which were related directly to increased harsh parenting. Fathers' involvement was associated directly with mothers' reduced economic hardship and reduced parenting stress when children were 3 to 5 years of age, and reduced levels of harsh parenting at 9 years of age. Harsh parenting during middle childhood, in turn, was associated directly and positively with boy's behavior problems at 9 years of age.ConclusionNonresident Black fathers' sustained involvement may buffer adverse consequences of stressful conditions on single mothers' parenting. This is important because studies have found that children growing up in households without the involvement of both biological parents are at greater risk for negative developmental and well‐being outcomes than their counterparts who grow up in households in which both biological parents are involved.ImplicationsThe most important scientific and policy implications of our results are that intervention approaches that focus on honing relationship and coparenting skills between unmarried nonresident, Black, biological fathers and the mothers of their children early on should be a high priority. Studies have found that although these couples are typically optimistic about their future together early in the relationship, most are no longer in a romantic relationship by the time the child is 5 years old.

Childhood Emotional and Conduct Problems in Childhood and Adolescence Differentially Associated with Intergenerational Maltreatment Continuity and Parental Internalizing Symptoms.

Caregivers' own childhood maltreatment experiences potentiate the risk for psychopathology and perpetration of maltreatment against one's children. In turn, both of these factors may negatively impact children's mental health. The nature of these intergenerational patterns of maltreatment may vary as a function of type of child outcome and may also be influenced by child age and sample characteristics (i.e., involvement of Child Protection Services, CPS). The present study uses a Structural Equational Model to examine cross-sectional relationships between caregiver maltreatment experiences in childhood and child-rated emotional and conduct problems and tests the mediational effect of caregiver internalizing symptoms and child maltreatment exposure. This sample is comprised of 791 children aged 3-16years (Mage = 10.6years; n = 302 3 to 8-year-olds, n = 489 9 to 16-year-olds; 51.5% male) and their caregivers (88.4% biological mothers). Children were recruited from CPS (n = 124), youth psychiatric services (n = 144), and the general population (n = 523). Results indicated indirect links between caregivers' childhood maltreatment experiences and their children's emotional and conduct problems. Specifically, caregiver-perpetrated child maltreatment predicted was related to child conduct problems, whereas both caregiver-perpetrated child maltreatment and caregiver internalizing symptoms were related to child emotional problems. Multi-group analyses revealed no moderation effect of CPS involvement. Our results highlight the importance of independent outcome-specific intergenerational patterns in prevention approaches for families with maltreatment experiences.

Do neighborhood social processes moderate the etiology of youth conduct problems?

Prior work has robustly suggested that social processes in the neighborhood (i.e. informal social control, social cohesion, norms) influence child conduct problems (CP) and related outcomes, but has yet to consider how these community-level influences interact with individual-level genetic risk for CP. The current study sought to do just this, evaluating neighborhood-level social processes as etiologic moderators of child CP for the first time. We made use of two nested samples of child and adolescent twins within the Michigan State University Twin Registry (MSUTR): 5649 families who participated in in the Michigan Twins Project (MTP) and 1013 families who participated in the Twin Study of Behavioral and Emotional Development (TBED-C). The neighborhood social processes of informal social control, social cohesion, and norms were assessed using neighborhood sampling techniques, in which residents of each twin family's neighborhood reported on the social processes in their neighborhood. Standard biometric GxE analyses evaluated the extent to which they moderated the etiology of CP. The 'no moderation' model provided the best fit to the data in nearly all cases, arguing against neighborhood social processes as etiologic moderators of youth CP. The neighborhood social processes evaluated here do not appear to exert their effects on child CP via etiologic moderation. The documented links between neighborhood social processes and child CP are thus likely to reflect a different etiologic process. Possibilities include environmental main effects of neighborhood social processes on child CP, or genotype-environment correlations.

Developmental trajectories of behaviour problems and prosocial behaviours of children with intellectual disabilities in a population-based cohort.

The study examined developmental trajectories of prosocial behaviours, internalising and externalising behaviour problems in children with intellectual disabilities (ID) between pre-school and middle childhood. Growth models examined the best-fitting trajectories for internalising and externalising behaviour problems, as well as prosocial behaviours, in 555 children with ID between the ages of three and 11years from the UK Millennium Cohort Study. Models were also fitted to examine the association of child outcomes with time-varying maternal psychological distress and life satisfaction. Finally, models were extended to compare trajectories with typically developing children. Externalising behaviour problems and prosocial behaviours generally improved, whereas internalising problems did not change systematically over time. A cubic trend indicated a slowing down of improvement between ages 5 and 7 for prosocial behaviours and externalising problems. Maternal psychological distress positively co-varied with internalising and externalising behaviour problems over time. Life satisfaction was not related to changes in child behaviours over time. Compared to behavioural trajectories in typical development, intercepts were worse and trajectories also differed in the ID group. Over an 8-year period, externalising behaviour problems and prosocial behaviours of children with ID tended to improve. These behavioural improvements slowed between five and seven years, possibly coinciding with school-related environmental changes. Children with ID significantly differ from children with typical development in both the initial level of difficulties (exhibiting higher externalising and internalising behaviours, and lower prosocial behaviours) and subsequent development as they age, showing comparatively lower decreases in both externalising and internalising behaviours, and lower increases in prosocial behaviours. Findings also highlight the significant role of maternal mental health problems in the trajectory of child behaviour problems.

Punitive versus Medicalized Responses to Childhood Behavior Problems and High School Graduation

There are significant racial and socioeconomic disparities in the use of suspensions and therapy/medication for childhood behavior problems. These disparities exacerbate inequalities elsewhere, including academic achievement. In addition, the unequal distribution of child social control also raises the question of whether unobserved heterogeneity between suspended and medicated children may explain the benefits of therapy/medication as an approach to child social control. In this study, I use data from the National Longitudinal Survey of Youth 1979–Child and Young Adult Survey to examine the relationship between early suspension or therapy/medication and high school graduation. Results of logistic regression models show that suspended children have lower odds of graduation than non-suspended/non-medicated children and children who only received therapy/medication. However, results of sibling comparison models that better condition on unobserved factors associated with child social control and academic achievement yield no significant differences in the odds of high school graduation across medicated and suspended siblings.

Social mediators of relationships between childhood reading difficulties, behaviour problems, and secondary school noncompletion

BackgroundChildhood reading difficulties (RDs) and behaviour problems (BPs) are well‐established predictors of secondary school noncompletion. However, few studies have examined the risk of secondary school noncompletion for children with differing combinations of the two childhood problems. Even less is known about potential mediators of relationships between the two childhood problems and secondary school noncompletion.AimsThis study examined whether key indicators of social connectedness—adolescent school engagement, and family and peer attachment—mediated relationships between childhood RDs and BPs and secondary school noncompletion.SampleData were drawn from the Australian Temperament Project, a longitudinal study that has followed a large community sample across 16 waves from infancy to adulthood.MethodsUsing standard reading and BP assessments, four childhood exposure groups were identified at 7–8 years: RDs‐only, BPs‐only, RDs + BPs, and Neither Problem.ResultsBoth groups with prior BPs had significantly poorer early‐adolescent school engagement, and family and peer attachment than the RDs‐only and Neither groups. School engagement mediated the relationship between childhood BPs and secondary school noncompletion but there was no evidence of similar mediation by family or peer attachment. Adolescent social connections did not mediate the effects of childhood RDs.ConclusionsThe adverse long‐term consequences of childhood BPs on secondary school noncompletion may be alleviated by targeting adolescent school engagement. Intervention implications are discussed.

Depression-related distortions in maternal reports of child behaviour problems.

Associations between maternal depression and child behaviour problems may be biased due to depression-related distortions in the maternal reports. In this study, we compared the agreement between maternal, teacher and child ratings of hyperactivity/inattention (H/I), conduct (CD) and emotional (EM) problems measured with the Strengths and Difficulties Questionnaire in a population with depressed and non-depressed mothers. The sample of 12,961 11-year-old children was drawn from the Danish National Birth Cohort. We also examined the association between maternal depression before and during the child's life and child H/I, CD and EM problems when reported by the different informants. Agreement between the informants was assessed with the Bland-Altman limits of agreement (LOA) and associations were analyzed using multiple linear regression models. We found large discrepancies between maternal and teacher ratings of child behavioural problems measured with the SDQ and less discrepancy between maternal and child self-ratings. Better agreement between informants was found in the population of depressed mothers compared to non-depressed mothers for H/I and CD problems, and not for EM symptoms. The LOA for all three subscales were wide in both populations, with the largest intervals ranging from - 6 (Lower LOA) to 3 (Upper LOA) for H/I. Statistically significant associations were found between maternal depression, and child H/I and CD problems when reported by the mother but not the teacher and only by the child, when maternal depression had been present during the child's life. Our findings emphasize the importance of considering each informants' ratings when obtaining ratings from multiple sources.

Parents' Spontaneous Attributions about their Problem Child: Associations with Parental Mental Health and Child Conduct Problems.

Parents' attributions about their child's personality and behaviour are known to predict the quality of parent-child interactions and outcomes for the child, including those from parenting interventions. Nothing is known, however, about the quantity and quality of attributions parents use during free speech about their children referred for treatment of behavioural and emotional problems. We tested hypotheses about the types of attributions and associations among parental attributions, parental psychopathology and child conduct problems, using 504 five-minute speech samples (FMSS) coded using the Parent Attribution Speech Sample (PASS) coding system. Both mothers and fathers talked about their thoughts and feelings regarding their children with disruptive behaviour problems (N = 295; 74% male; 3-8years old). The assessment of spontaneous parental attributions via the PASS coding system was shown to be valid and reliable. Mothers made more negative, dispositional attributions than fathers, however, parents of either gender made, on average, more positive than negative attributions about their children. Parents' natural attributions about these children with emotional and behavioural problems were rather independent from parents' own mental health, but were consistently related to child factors. Specifically, across parent gender and across all attribution dimensions, levels of callous-unemotional traits were associated with spontaneous parental attributions above and beyond other child and parent factors. Overall, the results show that parents' spontaneous speech about referred children contains important information about their causal attributions, and that these are associated with child temperament rather than specific referral symptoms.

Fathers’ and Mothers’ Early Mind-Mindedness Predicts Social Competence and Behavior Problems in Childhood

Parental mind-mindedness, the parent’s propensity to treat the child as an intentional agent, has repeatedly shown to promote children’s development of social understanding and secure attachment. Less is known about whether the impact of maternal and paternal mind-mindedness extends to children’s social and behavior problems. We investigated the combined effect of mothers’ and fathers’ (N = 104) mind-mindedness at 4, 12, and 30 months on children’s social competence and externalizing and internalizing behavior problems at 4.5 years. Besides, we examined the stability, continuity, parental concordance, and inter-parental differences in the use of mind-related comments. Appropriate mind-mindedness (i.e., correct interpretations of the child’s mental states) and nonattuned mind-mindedness (i.e., misinterpretations of the child’s mental states) were observed during parent-child free-play interactions. Social competence, internalizing and externalizing behavior problems were assessed using both parents’ reports. Hierarchical multiple regression analyses showed that, at 30 months, infrequent use of appropriate mind-related comments of both parents predicted children’s externalizing problems, while their frequent use of nonattuned comments predicted children’s low social competence. Furthermore, mothers’ frequent use of nonattuned comments at 12 and 30 months and fathers’ nonattuned comments at 30 months predicted children’s externalizing behavior. The findings suggest that both parents’ low use of mind-related comments, and frequent misinterpretations of their child’s mind, may act as risk factors for later social and behavior problems of their child.

Cognitive Behavioral Intervention for Youth at Risk for Conduct Problems: Future Directions

This article briefly overviews the history of cognitive behavioral intervention (CBI) for children displaying early signs, or actual diagnoses, of conduct disorders. A series of randomized control trials have identified evidence-based CBI programs for children with these behavior problems at various developmental stages from preschool through adolescence. Although it is critically important for the field to disseminate these existing programs as developed, we argue that it is important to also move beyond the existing evidence-based programs. Research should continue to test new comprehensive, multicomponent interventions, fueled by our evolving understanding of active mechanisms that contribute to children’s externalizing behavior problems. The future of research in this area can also benefit from a focus on four central issues. First, research can address how single interventions can have meaningful impact on a range of transdiagnostic outcomes because the intervention mechanisms may affect those various outcomes. Second, rooted in implementation science, we are beginning to understand better how evidence-based programs can be disseminated in the real world, examining key issues such as the adequacy of training approaches and the role of therapist and organizational characteristics. Third, a major focus of research can be on how to optimize intervention outcomes, including a focus on microtrials, on tailoring of interventions, on examining rigorously how interventions are delivered, and on the integration of technology and of other approaches such as mindfulness training into CBI. Fourth, research can explore how the therapeutic relationship and the therapists’ characteristics can play substantial roles in effective CBI with conduct problem children.

Changes in parental prosody mediate effect of parent-training intervention on infant language production.

Parent-training interventions to reduce behavior problems in young children typically coach parents on the content of their speech, but rarely assess parents' prosody during parent-child interactions. Infant-directed speech helps shape the parent-infant relationship and promote language development, which predicts adaptive behavioral outcomes in children. The current study examined (a) the effect of a parent-training intervention on parents' vocal cues in interactions with their infant and (b) whether parental prosody mediated the impact of the intervention on infant language production. Sixty families with 12- to 15-month-old infants (47% female; 95% of Hispanic/Latino ethnicity) participated in the Infant Behavior Program (IBP), a brief home-based adaptation of Parent-Child Interaction Therapy, or received standard pediatric care. Speech analysis was performed on mothers' (n = 40) utterances during infant-led play pre- and postintervention. Infants' number of utterances spoken during play was assessed at pre- and postintervention, and at 3- and 6-month follow-ups. Mothers who received the IBP spoke with greater pitch range and slower tempo postintervention, when controlling for baseline prosody. Change in these vocal cues, which are typical of infant-directed speech, mediated the effect of the intervention on infants' word production after 6 months. Interventions targeting the content of parents' speech during parent-infant interactions may lead to changes in parental prosody, which may be beneficial for infants' language development. Impaired linguistic abilities in infancy are strongly associated with behavior problems in later childhood; thus, these findings highlight a potential mechanism for intervention efficacy in promoting positive socioemotional and behavioral outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).