Family Behavior Problems Research Articles

Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial.

Early neurodevelopmental risks, compounded with traumatic medical experiences, contribute to emotional and behavioral challenges in as many as 1 in 2 children with congenital heart disease (CHD). Parents report a strong need for supports; yet, there remains a lack of accessible, evidence-based behavioral interventions available for children with CHD and their families. I-InTERACT-North is a web-based stepped-care mental health program designed to support family well-being and reduce behavioral concerns through positive parenting for children with early medical complexity. In previous pilot studies, the program was effective in increasing positive parenting skills and decreasing child behavior problems, with high parent-reported acceptability. This paper presents the protocol for the first randomized study of stepped-care parent support for families of children with CHD. This study will involve a single-site, 2-arm, single-blind randomized controlled trial to evaluate (1) the feasibility and acceptability of a web-based stepped-care parent support program (I-InTERACT-North) and (2) the effectiveness of the program in enhancing positive parenting skills and reducing behavioral concerns among families of children with CHD. Families will be randomized (1:1) to either receive treatment or continue with care as usual for 12 months. Randomization will be stratified by child's sex assigned at birth and baseline parent-reported child behavior intensity. Primary outcomes include positive parenting skills and child behavior at baseline, 3 months, 6 months, and 12 months. Secondary outcomes include parental mental health, quality of life, service usage, and feasibility including program reach and adherence. A sample size of 244 families will provide >95% power to detect an effect size of d=0.64. Based on attrition data from pilot studies, a target of 382 families will be enrolled. Parent reports of acceptability, adoption, and suggested adaptability of the program will be examined using cross-case thematic analyses. Primary efficacy analysis will be conducted using an intent-to-treat approach. Generalized estimating equations will be used to examine changes in positive parenting. Child behavior, quality of life, and parent mental health will be tested with repeated-measures analyses. Additional sensitivity and replication analyses will also be carried out. Recruitment began in February 2024, and recruitment and follow-up will continue until January 2029. We anticipate results in late 2029. This study aims to test the effectiveness of I-InTERACT-North web-based stepped-care parent support in improving positive parenting skills and reducing child behavior problems in families of children with CHD compared with a care as usual control group. Results will inform future clinical implementation and expansion of this program among families of children with early medical conditions. ClinicalTrials.gov NCT06075251; https://clinicaltrials.gov/study/NCT06075251. DERR1-10.2196/64216.

Coparenting Profiles and Children's Socioemotional Outcomes in Unmarried Parents with Low-Income.

This study aimed to examine patterns of mother-father coparenting relationship quality and their associations with child empathy, emotional insecurity, and behavior problems in families with low income. Given the growing number of nonmarital births and the high risk of relationship dissolution among cohabiting couples living with low income, it is important to examine the coparenting relationships among racially diverse unmarried couples from low-income contexts. To date, little research has assessed patterns of coparenting relationships and their associations with child socioemotional outcomes among this population. Participants were 4,266 unmarried couples and their preschool-aged children from the Building Strong Families study. Latent profile analysis was conducted. Latent profile analysis of survey data from mothers and fathers revealed four coparenting patterns: Profile 1: low quality, more negative maternal coparenting perceptions (7.2%); Profile 2: moderate-high quality, high congruence, slightly more negative paternal coparenting perceptions (25.2%); Profile 3: low congruence, severely more negative maternal coparenting perceptions (11.8%); and Profile 4: mutual high-quality coparenting (55.8%). Children of parents with the mutual high-quality coparenting profile had the most positive outcomes according to maternal reports of child socioemotional development. Highly congruent and positive perceptions of the other parent as a coparent were found to be significant promotive factors for positive child socioemotional development. Family strengthening policies and programs for unmarried couples with low income should target and support the development of mutually satisfying, high-quality coparenting relationships, with the ultimate goal to improve developmental outcomes for young children in such families.

Bidirectional associations between family conflict and child behavior problems in families at risk for maltreatment

BackgroundChildren's exposure to family conflict is associated with the development of behavior problems. However, it remains unclear whether this association (1) functions bidirectionally and (2) exists independent of more severe forms of violent victimization. ObjectiveThe present study aimed to examine bidirectional and transactional associations between family conflict and children's behavioral problems, controlling for time-varying violent victimization experiences. Invariance testing examined whether these models differed by gender and by maltreatment status prior to initial recruitment. Participants and settingParticipants were caregiver-child dyads identified prospectively as being at risk for maltreatment and family violence exposure prior to age four (N = 1281; 51.4 % female; 74.6 % persons of color). MethodsCaregivers were interviewed prospectively about family conflict, children's aggressive and delinquent behavior, and children's victimization experiences at child ages 6, 8, and 10. ResultsAfter controlling for prior victimization, significant cross-lagged bidirectional associations were identified between family conflict and child behavior problems. Indirect effects from age 6 to age 10 externalizing problems through age 8 family conflict were not supported. Several bidirectional paths were stronger among boys than girls. Results revealed little evidence for moderation by prerecruitment maltreatment status. ConclusionsFindings support a conceptualization of the family-child relationship that is reciprocal in nature and highlight the importance of non-violent, everyday negative family processes. Interventions aiming to improve child behavior problems by targeting severely dysfunctional family processes should also address non-violent, lower-level patterns of negative family interactions, such as everyday instances of blame, criticism, nonacceptance, and favoritism.

Changes in children's attachment security to mother and father after the birth of a sibling: Risk and resilience in the family.

Changes in children's attachment security to mother and father were examined for 230 firstborn children (M = 31.17 months), their mothers and fathers participating in a longitudinal investigation starting in the last trimester of the mothers' pregnancy and 1, 4, 8, and 12 months after the birth of an infant sibling. Both parents completed the Attachment Q-set at prenatal, 4, and 12 months. Growth mixture models revealed four latent classes in which children's attachments were (a) both secure with a modest decline to both parents (68.3%); (b) more secure with father than mother with a steep decline for both (12.6%); (c) both insecure with no change (10%); and (d) more secure with mother than father with a modest increase for both (9.1%). Multi-group latent growth curve analyses revealed that parenting and coparenting differed across families. Children had lower externalizing behavior problems in families with two secure attachments than in families with one secure attachment, either to mother or to father, who, in turn, had fewer problems than children with two insecure attachments. Findings underscore the strengths of a family systems framework to understand attachment relationships with multiple caregivers and the family risks and protective factors that covary with children's behavioral adjustment after the birth of a sibling.

Reciprocal Relations Between Maternal Depression and Child Behavior Problems in Families Served by Head Start.

This study used longitudinal cross-lagged modeling to examine reciprocal relations between maternal depression and child behavior problems. Data were drawn from 3,119 children (40% Hispanic, 30% African American, 20% White, and 10% other) from the Family and Child Experiences Survey of 2009 (a nationally representative sample of children served by Head Start). Results documented reciprocal relations between maternal depression and child behavior problems across early childhood (i.e., child age 3-5). Furthermore, the effect of child behavior problems on maternal depression was moderated by child race/ethnicity during children's first year in Head Start, such that the negative effect of child behavior problems on African American mothers' depression was more pronounced compared to Hispanics and other racial/ethnic groups.

Jailed Parents and Their Young Children: Residential Instability, Homelessness, and Behavior Problems.

This study examined family disruption in the form of jailed parents' housing instability in the year leading up to their most recent incarceration, including periods of homelessness with and without their children, and links between parental housing instability and children's behavior problems. Using the Family Stress Proximal Process Model to understand the links between stressors related to family disruption and child outcomes, the study analyzed data from interviews and surveys with 165 jailed fathers and mothers with young children (age 2-6 years) regarding jailed parents' reports of housing instability during the 12 months prior to their incarceration and child behavior problems. Analyses showed that housing instability, homelessness, and recidivism in jailed parents were relatively common, with a significant proportion of the disruptions occurring with young children, although many disruptions involved parental absence from children. Results indicated that the more months that parents lived with their children prior to incarceration in jail during the past year, the less housing instability the parents experienced. Additionally, multiple regression analyses revealed that more housing instability experienced by parents in the year leading up to their incarceration in jail were associated with elevations in children's internalizing and externalizing behavior problems. These results have implications for future research that explores family disruption as a mechanism in understanding recidivism and homelessness among adults and risk for child behavior problems in families affected by parental incarceration.

MATERNAL DEPRESSION AND THE DEVELOPMENT OF EXECUTIVE FUNCTION AND BEHAVIOR PROBLEMS IN HEAD START: INDIRECT EFFECTS THROUGH PARENTING.

The present study used a large, nationally representative sample of Head Start children (N=3,349) from the Family and Child Experiences Survey of 2009 (FACES) to examine associations among maternal depression (measured when children were ˜36 months old) and children's executive function (EF) and behavior problems (measured when children were ˜48 months old). Preliminary analyses revealed that 36% of mothers in the sample had clinically significant levels of depressive symptoms. Furthermore, a path analysis with demographic controls showed a mediation effect that was significant and quite specific; mother-reported warmth (and not mother-child reading) mediated the path between maternal depression, children's EF, and behavior problems. Findings provide empirical support for a family process model in which warm, sensitive parenting supports children's emerging self-regulation and reduces the likelihood of early onset behavior problems in families in which children are exposed to maternal depression.

Parental Stress, Discipline Strategies, and Child Behavior Problems in Families With Young Children With Autism Spectrum Disorders

The current study investigated the parent–child relationship by examining associations between parent stress, parental discipline strategies, child disruptive behavior problems, and level of autism spectrum disorder (ASD) symptoms. A sample of 130 parents of children with ASD ages 3 to 11 years participated. Parents reported high levels of parent stress and high levels of child disruptive behavior problems. A series of mediation analyses via bootstrapping were used to examine the development of child disruptive behavior. Use of harsh and punitive parental discipline strategies mediated the link between parent stress and child disruptive behavior problems. These findings suggest that parental discipline strategies should be a central target in prevention and treatment interventions for children with ASD to reduce the emergence of child disruptive behavior problems. Reducing challenging behavior in children with ASD may improve the rate of skill acquisition and improve the parent–child relationship. Future directions for research along with clinical implications for families are discussed.

Clinical and psychological characteristics and quality of life in teenagers with а long-lasting low-grade fever both associated and not associated with hypothalamic syndrome

Aim. To describe clinical and psychological characteristics and quality of life in teenagers with a long-lasting low-grade fever associated with hypothalamic syndrome. Methods. Life history, objective status were assessed, clinical, laboratory and instrumental examinations were performed, quality of life and psychological status were estimated throughout the study. Clinical and laboratory investigations included complete blood count, urinalysis, stool examination; blood immunochemistry for mycoplasma, chlamydia, herpes virus, cytomegalovirus; blood biochemistry; bacteriology of nose and the pharynx swabs. Instrumental investigations included skull and cervical spine X-Ray, neurophysiological examinations (electroencephalography, echoencephalography, rheoencephalography), cranial and cervical blood vessels ultrasonography. The quality of life was estimated using special pediatric questionnaires (proposed by Molchanova L.F., Izhevsk State Medical Academy). Psychological status was assessed by questionnaires of H. Eysenck (temperament assessment) and C.D. Spielberg (research of personal and situation anxiety). Results. All teenagers underwent a complex treatment according to diagnosis, including antimicrobial treatment in case of chronic infections, antimicrobial treatment and immunostimulators in case of upper and lower airway infections caused by chlamydia and mycoplasma, correction of functional conditions of central nervous system (nootropics, vasoactive drugs, diuretics, anxiolytics, metabolic medications, hypotensives), massages, exercise therapy, physiotherapy, herbal treatment. After the course of treatment relapse of low-grade fever was 4-fold more often in teenagers with hypothalamic syndrome compared to those without. Teenagers with low-grade fever associated with hypothalamic syndrome had higher rates of melancholy, higher anxiety levels, leading to significant alterations of physical and mental health. Those changes may lead to mental and social adaptation problems, borderline social and family behavior, and increased rate of psychosomatic diseases. Conclusion. As it was revealed that relapsing low-grade fever might lead to reduced quality of life, further exacerbations of borderline mental problems, aggravate mental adaptation and social and family behavior problems, these teenagers require family and individual mental therapy, repeated treatment with nootropics, vasoactive drugs, diuretics, anxiolytics.

Maternal Parenting Behavior and Child Behavior Problems in Families of Children and Adolescents with Autism Spectrum Disorder

Parents of a child with autism spectrum disorder (ASD) face specific challenges in parenting, but concrete parenting behavior has never been properly investigated in these families. This exploratory questionnaire study compared parenting behaviors among mothers of children and adolescents with ASD (n = 552) and without ASD (n = 437) and examined associations between child behavior problems and parenting behavior. Results showed that mothers of children with ASD reported significantly lower scores on Rules and Discipline and higher scores on Positive Parenting, Stimulating the Development, and Adapting the Environment. Age was differently related to parenting behavior in the ASD versus control group. Furthermore, distinctive correlation patterns between parenting behavior and externalizing or internalizing behavior problems were found for both groups.

COMPLIANCE, OPPOSITION, AND BEHAVIOR PROBLEMS IN TODDLERS BORN PRETERM OR LOW BIRTHWEIGHT.

Although children born preterm or low birth weight (PT LBW) are more likely to exhibit behavior problems compared to children born at term, developmental and family processes associated with these problems are unclear. We examined trajectories of maternal depressive symptoms in relation to toddler compliance and behavior problems in families with PT LBW infants. A total of 177 infants (93 boys, 84 girls) and their mothers enrolled in the study during the infant's NICU stay. Data were collected at five time points across 2 years. Assessments of maternal depressive symptoms were conducted at all time points, and toddler compliance and opposition to maternal requests and behavior problems were assessed at 2 years. Toddlers born earlier with more health problems to mothers whose depressive symptoms increased over time exhibited the most opposition to maternal requests during a cleanup task at 24 months, consistent with multiple risk models. Mothers with elevated depression symptoms reported more behavior problems in their toddlers. The study has implications for family-based early intervention programs seeking to identify PT LBW infants at highest risk for problem behaviors.

Feeding problems reported by parents of young children with type 1 diabetes on insulin pump therapy and their associations with children’s glycemic control

Previous research demonstrated high rates of perceived mealtime behavior problems in families of young children with type 1 diabetes who were managed with conventional therapy. Because of new insulin regimens that offer greater flexibility, reexamination of mealtime behaviors is required. We assessed parent-reported mealtime behaviors in a sample of young children using an insulin pump. An additional aim was to evaluate the associations of two measures of parental feeding behavior with children's glycemic control. Primary caregivers of 31 young children (mean age = 5.0 +/- 1.3 yr) completed the Child Feeding Questionnaire (CFQ) and the Behavioral Pediatric Feeding Assessment Scale (BPFAS). Hemoglobin A1c (HbA1c) was used as a surrogate marker for children's glycemic control. Children had a mean HbA1c of 7.8 +/- 0.64%. Mean CFQ - Restriction and Pressure to Eat scores were 3.1 +/- 0.94 and 2.0 +/- 0.88, respectively (range = 1-5). Mean BPFAS - Parent and Child scores were 16.0 +/- 4.3 (range = 10-50) and 44.9 +/- 9.3 (range = 25-125), respectively. Positive correlations were found between children's HbA1c levels and caregivers' reporting of frequency of child mealtime behavior problems. Caregivers of young children on pump therapy report relatively low rates of mealtime behavior problems. However, correlations with children's HbA1c suggest that parent-child mealtime behaviors continue to relate to children's health outcomes. Research is needed to determine if changing mealtime interactions can improve children's glycemic control; items from the BPFAS and CFQ can offer targets to guide interventions.

The Illustration-Based Assessment of Liability and EXposure to Substance use and Antisocial behavior© for Children

Background/Objectives: Ontogenetic prevention of substance abuse requires that an individual's “profile” of substance abuse predictors is assessed to guide intervention decision-making (). For child intervention, self-report data provide information that cannot be obtained from other sources such as parents or teachers. However, efficient child report instruments of substance abuse risk factors are lacking. The Assessment of Liability and EXposure to Substance use and Antisocial behavior© (ALEXSA©) is an illustration-based, computerized child report assessment for early manifestations and predictors of substance abuse and antisocial behavior. Methods: Construct validity and test-retest reliabilities of ALEXSA subscales were estimated in 272 nine to twelve-year old students from regular and remedial education classrooms. Results: Anecdotal and quantitative data demonstrated that children enjoy the ALEXSA format. All factors and 34 of 39 subscales had good or better reliabilities. Nine factors were extracted: Disinhibition (example subscales are Irritability, Impulsivity), Sensation Seeking (e.g., Gambling, Social Disinhibition), Self Management (e.g., Planning and Concentration, Problem Solving), Family Discord (e.g., Family Behavior Problems, Family Conflict), Parent Fortification (e.g., Parental Monitoring, Parent Attachment), Social Contagion (e.g., Friends' Conduct Disorder Criteria, Peer Pressure Susceptibility), Social Support (e.g., Social Support: Adults, Number of Friends), Neighborhood Risks (e.g., Gang Exposure, Neighborhood Atmosphere), and School Protection (e.g., Academic Competency, School Commitment). Scientific Significance: The ALEXSA could provide efficient child reports for research, needs assessment, and outcomes to support etiology and prevention of substance abuse and antisocial behavior.

Family Conflict and Children's Behavior Problems: The Moderating Role of Child Temperament

Child temperament was examined as a moderator of the link between family conflict and child behavior problems. Temperament assessed in early childhood was used to predict the relation between family conflict and externalizing behavior problems measured during the early elementary school years. For children with difficult temperament, a strong association between subsequent family conflict and behavioral adjustment was predicted; for children with easy or intermediate temperaments, low to moderate associations were predicted. These hypotheses were tested across 3 temperament groups (easy, intermediate, and difficult). Data were collected from 108 children and families participating in the Fullerton Longitudinal Study at ages 3 through 10 years. Consistent with the hypotheses, the data provided support for the moderating role of temperament in predicting the association between family conflict and child externalizing behavior problems. These findings suggest that temperamental difficultness operates as a vulnerability factor with respect to the development of children's behavior problems in families with high conflict.

Treatment of depressed mothers with disruptive children: A controlled evaluation of cognitive behavioral family intervention

This study compared the effects of two forms of behavioral family intervention in reducing mothers' depression and disruptive behavior problems in families with a clinically depressed parent and a child with significant conduct problems. Forty-seven parents were randomly assigned to either a Behavioral Family Intervention (BFI) or to Cognitive Behavioral Family Intervention (CBFI) which integrated cognitive therapy strategies to treat depression and teaching of parenting skills. Both treatments were equally effective in reducing mothers' depression and child disruptive behavior on observational and self-report measures at postintervention. However, at 6-month follow-up more families in CBFI (53%) compared to BFI (13%) experienced concurrent clinically reliable reductions in maternal depression and child disruptive behavior. These findings support the value of CBFI in reducing depression in mothers of children with disruptive behavior problems.

Physical violence and other forms of marital aggression: Links with children's behavior problems.

Two studies examined whether physical marital violence and other forms of marital aggression (e.g., threats, throwing objects) correlate with children's behavior problems in families marked by recent spousal violence. Study 1 included 55 families seeking marital therapy. Study 2 included 199 families at battered women's shelters. In the marital therapy sample, both physical marital violence and other forms of marital aggression correlated positively with children's externalizing problems. In the women's shelter sample, physical violence and other forms of marital aggression correlated positively with children's externalizing and internalizing problems. After accounting for the frequency of physical marital violence, forms of marital aggression other than physical violence still related to children's externalizing problems in the marital therapy sample and to children's internalizing problems in the women's shelter sample. Physical marital violence, operationalized as physical assault on an intimate partner's body, is very prevalent among families in the United States, with up to 50% of married couples experiencing spousal violence at some point during the course of their marriages (Straus & Gelles, 1990; Straus, Gelles, & Steinmetz, 1980).] Relationships between physical marital violence and children's behavior problems have been investigated with some vigor over the past decade, and empirical evidence clearly indicates that children growing up in families marked by such violence are at increased risk for clinical