Child Behavioral Difficulties Research Articles

Characteristics of temper tantrums in 1-6-year-old children and impact on caregivers.

Temper tantrums are common behavioral difficulties in children. Although they are generally considered a normal part of development, certain characteristics-such as aggression, prolonged duration, and frequent occurrences-have been linked to psychological issues and can negatively impact both the child and their caregivers. To study the prevalence and characteristics of temper tantrums in children aged 1-6 years at daycare and in kindergarten in Thailand as well as the impact of problematic and non-problematic tantrums on their caregivers' emotional well-being. This cross-sectional descriptive study was conducted in 2021. The main caregivers of the participants completed self-reported questionnaires that collected their demographic information and the temper tantrum characteristics and impacts on the caregivers' emotions. Data from 211 children were included in this study. The mean child age was 4.4 ± 1.2 years. Two hundred and one (95.3%) parents reported that their children had at least one tantrum behavior, of which verbal were the most common (94.5%). One hundred and eleven (55.2%) children had tantrums defined as problematic: exhibiting aggressive physical behavior, duration >15 min, frequency > 3 days/week. The mean emotional burden scores of the children's problematic and non-problematic temper tantrums on their parents were 23.3 ± 8.4 and 17.7 ± 8.3 (maximum, 55; p = 0.001), respectively, showing a statistically significant difference. Tantrums are common in children aged 1-6 years, but their expression varies. Problematic tantrums were reported for approximately half of the children and significantly impacted their caregivers' emotions. Therefore, children with problematic tantrums and their families should receive assistance.

Instruments evaluating child outcomes used in evidence-based family support programs: A scoping review

This scoping review aims to identify instruments that measure child outcomes assessed in evidence-based family support programs and to investigate reported differences in the magnitude of Cronbach’s alpha by type of study participant (i.e., community, clinical, at-risk samples). We analyzed publications extracted from three databases, which were then narrowed down to 77 articles. The most used interventions were Triple P (23 studies), Incredible Years (13), and Parent Management Training (13) conducted mainly in Europe (35) and (North) America (25). A total of 30 studies were conducted with clinical, 22 with at-risk, and 22 with community samples. The most used instruments with parents as the respondents were the Eyberg Child Behavior Inventory (32), the Strengths and Difficulties Questionnaire (25), and the Child Behavior Checklist (19). The most used instrument with children/adolescents as the respondents was the Child Depression Inventory (5), and for teachers or other professionals it was the Teacher Report Form (9). Regarding Cronbach’s alpha, one-third of the studies did not report any information, one-third yielded mixed findings, and one-third reported good values. Furthermore, it became evident that information regarding Cronbach’s alpha was often incomplete or missing, especially in studies conducted with clinical and at-risk samples. Further research is needed to investigate why there is a bias in reporting Cronbach’s alpha. This work recommends that future studies emphasize the importance of reporting the psychometric properties of the instruments used to be able to properly compare different studies across different populations, especially when used to measure children’s outcomes.

Assessment tools used to measure postoperative behavioral changes in children, a narrative review

Context: Previous studies have shown a high prevalence of postoperative behavior changes in children. To assess postoperative behavior changes, various tools have been used and the understanding of their psychometric characteristics namely validity, reliability and norming is essential. Objective: To provide an overview of the different assessment tools used to measure postoperative behavior changes in children and their psychometrics. Methods: Data sources: MEDLINE, EMbase, Web of Science and Google Scholar. Study selection: inclusion of studies published between January 1995- June 2023 and searched with the following key terms: ‘anesthesia’, ‘postoperative behavior’ and ‘child’ and MESH terms ‘postoperative period’, ‘behavior’ and ‘child’. Data extraction and data synthesis: a data extraction form was used and due to heterogeneity, the findings are presented as a narrative review. Results: In the final analysis, 57 articles were withheld and 11 assessment tools identified which were used to measure postoperative behavior changes. In the majority of these studies, the Post Hospitalization Behavior Questionnaire (PHBQ) and its adaptation namely the Post Hospitalization Behavior Questionnaire for ambulatory surgery (PHBQ-AS) were used. Although frequently applied, the validity, reliability and norming of both questionnaires have not been well established. Other tools like the Child Behavior Checklist, the Strengths and Difficulties Questionnaire and Infant/Toddler Sensory Profile have been well validated and are reliable. However, these tools were not specifically designed for assessment of postoperative behavior changes in children after surgery. Conclusions: There is a lack of well validated and reliable tools to assess postoperative behavior in children both for clinical and research purposes.

Are a Child's Autistic Traits, Behavioural Difficulties, Prosocial Behaviour and Temperament Predictors of Parental Self-Efficacy and Satisfaction? A Study on Parents of Autistic and Neurotypical Children Aged 7-11 Years.

The aim of the study was to evaluate the significance of the severity of autistic traits, behavioural difficulties, prosocial behaviour and temperamental characteristics in children for parental self-efficacy and parental satisfaction in two groups of parents: parents of autistic children, and parents of neurotypical children. Data come from 145parents of autistic children and 239 parents of neurotypical children. Using hierarchical multiple regression analyses, the analysis explored the role of child characteristics in prediction of parental self-efficacy and parental satisfaction. The regression model tested explained 21% variation in parental self-efficacy and 27% variation in parental satisfaction in parents of autistic children and 3% of variation of results with respect to parental self-efficacy and 17% variation in parental satisfaction in parents of neurotypical children. In both groups, parental self-efficacy and parental satisfaction were negatively correlated with such child characteristics as severity of behavioural difficulties, severity of autistic traits and emotionality as also positively related to the child's prosocial behaviour. These findings may suggest that particularly useful mental health prevention programs for parents should combine two elements: developing parents' abilities of effectively coping with children's behavioural difficulties and working on attribution processes and negative convictions about parenthood.

Paternal and Maternal Exposures to Per- And Polyfluoroalkyl Substances and Child Behavioral Difficulties

Paternal and Maternal Exposures to Per- And Polyfluoroalkyl Substances and Child Behavioral Difficulties

Co-production of the ‘EPIC’ multidimensional tool-kit to support neurodivergent children and young people at home and school: a feasibility and pilot study

BackgroundInterventions focused on cognitive function in neurodivergent children typically focus on single functions, e.g. working memory training. They are often focused on ‘deficit’ models and lack an emphasis on understanding areas of individual strengths and difficulties as a prerequisite to appropriate support. The multidimensional nature and phenotypic variability of cognitive profiles in these children indicate a need for a multicomponent-tailored intervention programme focused on understanding and supporting an individual child’s cognitive functioning.AimsThe ‘EPIC’ intervention (Edinburgh Psychoeducation Intervention for Children and Young People) is focused on improving cognition, learning and behaviour in neurodivergent children such as those with attention deficit hyperactivity disorder (ADHD) or who are autistic. Building on our previous co-production work, this study aimed to use a participatory methods approach to develop EPIC practices and materials in relation to our key principles which include psychoeducation, multicomponent, individualised approach, strengths and difficulties profiling and pairing of a child’s individual strengths and difficulties with internal and external strategies. We also set out to assess the feasibility and acceptability of EPIC, and pilot this novel tool-kit intervention with neurodivergent children and their parents and teachers.MethodsThe intervention practices, materials and strategies of EPIC were co-produced with neurodivergent children, their parents, teachers and clinicians taking a strengths and difficulties approach. Identification of psychoeducation activities and strategy practices (e.g. mind-maps, chunking), testing of feasibility and collection of pilot data were conducted over a bi-weekly 8-week programme. Eleven neurodivergent children aged 7 to 12 completed the 16-session individualised programme. Acceptability and feasibility were ascertained via qualitative reports elicited within child and teacher interviews and child ratings of enjoyment. Pilot evaluation data was collected pre- and post-intervention participation, and across cognitive assessments (CANTAB, BRIEF), educational attainment (WIAT) and parent and teacher questionnaires measuring clinical symptoms and behaviour (Conners, AQ, SDQ, self-perception). Data was compared with a matched neurodivergent treatment-as-usual control group (N = 9).ResultsThe co-produced EPIC intervention was both feasible to deliver and acceptable to children, parents and their teachers. Pilot data identified that the 8-week intervention improved cognition (short-term and working memory) and literacy (receptive vocabulary, oral word fluency, listening comprehension). Improvements in the intervention group were also found for parent-reported child behavioural difficulties and aggression, and teacher-reported scholastic competence. Effect sizes generated (Cohen’s d) ranged from 0.65 to 2.83. Parents reported continuing to use EPIC strategies when interviewed over a year after participating in the programme.ConclusionThe current study met our objectives fully. ‘EPIC’ (Edinburgh Psychoeducation Intervention for Children and Young People) is feasible in home and school contexts and improves a range of aspects of cognition, learning and behaviour in neurodivergent children. Our findings show EPIC is suitable to be assessed within a full-scale trial.

Family Therapy for Kosovar Mothers Who Experienced Conflict-Related Sexual Violence and Their Children in Postwar Times: A Pilot Randomised Waitlist-Controlled Trial.

Women who have experienced conflict-related sexual violence report significant long-term effects, including posttraumatic stress disorder (PTSD), depression and relationship difficulties. Research has demonstrated that maternal trauma is associated with children's behavioural difficulties and challenges in family functioning, such as impaired communication and harsh parenting. This pilot study is aimed at evaluating the preliminary effectiveness of family therapy for Kosovar mothers who experienced conflict-related sexual violence in 1998-1999 and later developed PTSD and their children in improving family functioning and reducing behavioural difficulties in postwar times. Sixty-four mothers were randomised to an intervention group or a waitlist control group. Data was collected during a screening phase, at baseline before intervention initiation, after the intervention group completed family therapy and once the waitlist control group received the intervention. Generalised linear mixed models were used to analyse group differences in family functioning and children's behaviours over time. At follow-up, mothers in the intervention group reported improved family functioning. However, mothers in the waitlist control group reported significantly fewer behavioural difficulties than mothers in the intervention group before the control group had started family therapy. There was no significant interaction between group condition and time for child-rated family functioning. Overall, this pilot study suggests that family therapy could be effective in reducing the effects of intergenerational trauma related to PTSD and conflict-related sexual violence. Future research should evaluate the long-term effects of family therapy to assess if immediate effects were maintained.

Experiences and support for caregivers of infants and young children: 2019–20 bushfires

During emergencies, infants and young children are vulnerable. However, Australia lacks emergency planning and guidance specifically addressing the needs of these children and their caregivers. A total of 256 caregivers (predominately mothers) of children aged 0–4 years were surveyed or interviewed about their experiences during and after the summer bushfires in Australia in 2019–20. In addition, 63 emergency responders were surveyed or interviewed regarding their experiences supporting families with young children, including during the 2019–20 bushfires. Analysis of the surveys and interviews revealed parents were under prepared for the bushfires and preparedness was hampered by a lack of tailored guidance for families. Evacuations were often delayed due to lack of planning and were complicated because of the continuing care needs of children. Evacuation centres presented numerous child-safety risks and women who evacuated on their own particularly struggled to care for their children. Parenting children after the bushfires could be challenging and reports of child behaviour difficulties suggest the effects of the emergency on parents had adverse affects on children. Recovery interventions largely overlooked children younger than school age. Caregivers of infants and young children require targeted preparedness, response and recovery support. This research provides evidence to inform planning and to guide development.

Insecure maternal employment and children's behaviour difficulties: Evidence from the longitudinal study of Australian children

Although a large body of research has documented the negative effects of insecure employment for adult workers, less is known about the consequences for their children's well-being. Our understanding of the mechanisms through which insecure maternal employment may affect children is particularly limited. This study examines the relationship between insecure maternal employment and child behaviour difficulties from the age of 4–16 using seven waves of data for nearly 5000 families from Growing Up in Australia: The Longitudinal Study of Australian Children. Employing fixed effects models to account for unobserved time-invariant heterogeneity, we found that children whose mothers were casual contract employees or economically inactive had greater behaviour difficulties, on average, than their peers whose mothers were permanent employees. Maternal mental health and parenting, rather than household financial strain, contributed to explaining the association between insecure maternal employment and child behaviour difficulties. These results were more pronounced for younger children (up to the age of 12). This study contributes to the literature on the consequences of maternal employment insecurity for child mental health in high-income countries by clarifying the mechanisms behind this association.

Effects of the COVID-19 Pandemic on the Lifestyle and Mental Health of Children in the Puducherry District: A Community-Based Cross-Sectional Study.

The COVID-19 pandemic has tremendously disrupted societal behaviors and norms. People had to cope with new situations, including restrictions on free movement, home confinement, and school closures, among others. With less scope for physical classes, online classes became rampantly common during and after the pandemic. A virtual learning platform cannot replace the societal learning and preparation of children that normally occurs in school settings. The pandemic had a multifaceted impact on children, disrupting their routine work, social life, and mental health. Such uncertain circumstances are bound to interfere with their emotional well-being, with long-term consequences. It is imperative to screen for the effects of the pandemic situation among children for timely action. A cross-sectional survey was carried out in both rural and urban areas of Puducherry, India, between February and April 2022, toward the fag end of the pandemic. Face-to-face interviews were conducted among caregivers of 621 children aged 6-17 years. Details such as sociodemographic, personal, and behavioral aspects of the child were collected. Emotional and behavioral difficulties during the pandemic were assessed using the parent (caregiver) version of the Strengths and Difficulties Questionnaire-25 (SDQ-25). Univariate analysis was performed using the chi-square test. Four different regression models were fitted to ascertain the factors influencing the overall difficulty score as well as the SDQ subscales, namely, the internalizing, externalizing, and prosocial scores. A P value of <0.05 was considered significant. Overall, 101 (16.3%) children aged 6-17 years were likely to have emotional and behavioral difficulties according to the SDQ scores. Abnormal externalizing, internalizing, and prosocial scores were documented among 160 (25.8%), 258 (41.5%), and 285 (45.9%) children, respectively. Caregivers reported disruptions in their children's academic performance (426, 68.6%), sleeping patterns (269, 43.3%), and eating habits (256, 41.2%). The use of digital devices for noneducational purposes was reported among 97 (35.9%) children. Younger caregivers (18-45 years), children who used digital devices for >2 hours per day, children who experienced any death due to COVID-19 in their family, and caregivers who perceived that the psychological changes in their children were due to the pandemic were predictors of abnormal SDQ scores. Physical activity for more than two hours per day reduced the risk of emotional and behavioral difficulties in children by 60%. This research underscores the potential ramifications of the pandemic on the mental well-being and lifestyle of children. Implementing initiatives that promote positive mental health and conducting preventive screening for vulnerable populations, such as children, are considered essential, anticipating the challenges posed by such unprecedented pandemic circumstances in the future.

Family engagement in a behavioral parenting intervention: A randomized comparison of telehealth versus office-based treatment formats.

Despite effective treatment options, many families-especially those from marginalized backgrounds-lack access to quality care for their children's behavioral difficulties. Since the COVID-19 pandemic, telehealth has become a prominent format for the delivery of outpatient services, with potential to increase access to quality care. Although telehealth-delivered parenting interventions are associated with positive clinical outcomes, limited research has examined whether telehealth formats improve treatment engagement relative to office-based care. The present study is the first controlled comparison of engagement across office-based parent-child interaction therapy (PCIT) and internet-delivered PCIT (iPCIT). Children ages 3-5 years, and their caregiver(s) (N = 40) participated in a randomized trial comparing iPCIT to office-based PCIT in the treatment of behavioral problems. Analyses examined the effects of treatment format on engagement (i.e., missed sessions, premature treatment discontinuation, homework completion, therapeutic alliance, and treatment satisfaction). Logistic and linear regressions further explored whether treatment format moderated the effects of common predictors of treatment engagement (i.e., family economic means, racial/ethnic background, caregiver stress). iPCIT improved attendance rates relative to office-based PCIT, especially for families from minoritized racial/ethnic backgrounds. At the same time, among families with relatively higher levels of caregiver stress, office-based PCIT was associated with lower dropout rates and improved treatment alliance and satisfaction, relative to iPCIT. This study provides the first experimental support that telehealth formats can improve treatment attendance in behavioral parenting interventions. Findings highlight nuances in treatment engagement across treatment formats that reveal limits to the extent telehealth transcends engagement concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Machine learning-based health environmental-clinical risk scores in European children

BackgroundEarly life environmental stressors play an important role in the development of multiple chronic disorders. Previous studies that used environmental risk scores (ERS) to assess the cumulative impact of environmental exposures on health are limited by the diversity of exposures included, especially for early life determinants. We used machine learning methods to build early life exposome risk scores for three health outcomes using environmental, molecular, and clinical data.MethodsIn this study, we analyzed data from 1622 mother-child pairs from the HELIX European birth cohorts, using over 300 environmental, 100 child peripheral, and 18 mother-child clinical markers to compute environmental-clinical risk scores (ECRS) for child behavioral difficulties, metabolic syndrome, and lung function. ECRS were computed using LASSO, Random Forest and XGBoost. XGBoost ECRS were selected to extract local feature contributions using Shapley values and derive feature importance and interactions.ResultsECRS captured 13%, 50% and 4% of the variance in mental, cardiometabolic, and respiratory health, respectively. We observed no significant differences in predictive performances between the above-mentioned methods.The most important predictive features were maternal stress, noise, and lifestyle exposures for mental health; proteome (mainly IL1B) and metabolome features for cardiometabolic health; child BMI and urine metabolites for respiratory health.ConclusionsBesides their usefulness for epidemiological research, our risk scores show great potential to capture holistic individual level non-hereditary risk associations that can inform practitioners about actionable factors of high-risk children. As in the post-genetic era personalized prevention medicine will focus more and more on modifiable factors, we believe that such integrative approaches will be instrumental in shaping future healthcare paradigms.

Linking child adjustment difficulties with mother's maladaptive parental behavior: The mediating roles of parental cognitions and parenting stress.

Child abuse is prevalent worldwide, with most of the burden in developing countries. To reduce and prevent child abuse occurrence, many efforts are directed toward reducing maladaptive parental behaviors (MPBs), a predictor of parents' risk of engaging in child abusive behaviors. MPBs have been associated with child (e.g., behavioral difficulties) and parent characteristics (e.g., parenting stress and parental cognitions), although little research tested for mediational pathways. This study aimed to test the pathways through which child and parent characteristics are linked to MPB. Consistent with the social information processing model of parenting, we hypothesized that child behavioral difficulties would exert an indirect influence on MPB through parenting stress and that parenting stress will exert a direct and indirect effect on MPB through parental cognitions (i.e., expectations, attitudes, and attributions). This study used data from 243 mothers of children aged between 2 and 9 years in Romania. Two-stage structural equation modeling was employed to test the hypothesized model. Results support the role of child behavior, parenting stress, and parental cognitions in predicting MPB (R2 = 0.69). Significant indirect effects were found from child behavior to MPB via parenting stress and parental cognitions. Direct effects from parenting stress and parental cognitions to MPB were significant. Findings show that parenting stress and parental cognitions are important mechanisms through which child behavioral difficulties influence maladaptive parental behavior, underscoring the need to focus on these mechanisms when assessing or intervening with families at risk for child abuse.

Associations Between Preadoption Maltreatment and Adoptees’ Emotional and Behavioral Difficulties: The Buffering Role of Mindful Parenting

ObjectivesThe main goal of this study was to explore the association between preadoption maltreatment and postadoption child emotional and behavioral difficulties (EBD), while examining the potential buffering role of adoptive parents’ mindful parenting on this association. The potential moderating role of the child’s current age, of the time passed since the adoptive placement, and of the parents’ sex was also explored within the buffering role of mindful parenting.MethodThis cross-sectional study comprised a sample of 277 parents (76.2% females) with adoptive children aged 2 to 17 years.ResultsExperiencing preadoption maltreatment and more diverse types of maltreatment were associated with higher EBD among adoptees as perceived by the parents. Mindful parenting had a buffering role in the association between preadoption maltreatment and EBD for adoptees up to 8 years of age and an independent direct explanatory role on EBD for adoptees of all other ages.ConclusionsIntervening with adoptive parents through mindful parenting programs seems to be relevant to promote adoptees’ mental health.PreregistrationThis study is not preregistered.

Collateral Child and Parent Effects of Behavioral Sleep Interventions for Children with Rare Genetic Neurodevelopmental Conditions

Abstract Objectives This study, following Woodford et al. (2024), investigated the collateral child and parent effects of function-based behavioral sleep interventions for 21 children with rare genetic neurodevelopmental conditions (RGNC). Methods Measures completed by parents at pre- and post-intervention assessed change in children’s internalizing and externalizing symptoms, health-related quality of life, behavioral strengths and difficulties, as well as parental sleep, relationship quality, and mental health symptoms. Data were analysed using modified Brinley plots and effect size estimates. Results Results demonstrate modest collateral benefits across child emotional and behavioral difficulties and health-related quality of life, and maternal anxiety and stress symptoms and sleep quality. There was minimal improvement in parent ratings of child externalizing symptoms and physical health-related quality of life, parent relationship satisfaction and all paternal outcome measures. There was no statistically significant relationship between changes in collateral outcomes and sleep problem severity. Conclusions Findings underscore the diverse potential benefits of improved sleep and highlight the need for further prioritisation of sleep services and research in RGNC.

Maternal concentrations of environmental phenols during early pregnancy and behavioral problems in children aged 4 years from the Shanghai Birth Cohort

BackgroundPrenatal exposure to environmental phenols such as bisphenol (BPs), paraben (PBs), benzophenone (BzPs), and triclosan (TCS) is ubiquitous and occurs in mixtures. Although some of them have been suspected to impact child behavioral development, evidence is still insufficient, and their mixed effects remain unclear. ObjectivesTo explore the association of prenatal exposure to multiple phenols with child behavioral problems. MethodIn a sample of 600 mother–child pairs from the Shanghai Birth Cohort, we quantified 18 phenols (6 PBs, 7 BPs, 4 BzPs, and TCS) in urine samples collected during early pregnancy. Parent-reported Strengths and Difficulties Questionnaires were utilized to evaluate child behavioral difficulties across four subscales, namely conduct, hyperactivity/inattention, emotion, and peer relationship problems, at 4 years of age. Multivariable linear regression was conducted to estimate the relationships between single phenolic compounds and behavioral problems. Additionally, weighted quantile sum (WQS) regression was employed to examine the overall effects of the phenol mixture. Sex-stratified analyses were also performed. ResultsOur population was extensively exposed to 10 phenols (direction rates >50 %), with low median concentrations (1.00 × 10−3–6.89 ng/mL). Among them, single chemical analyses revealed that 2,4-dihydroxy benzophenone (BP1), TCS, and methyl 4-hydroxybenzoate (MeP) were associated with increased behavior problems, including hyperactivity/inattention (BP1: β = 0.16; 95 % confidence interval [CI]: 0.04, 0.30), emotional problems (BP1: β = 0.11; 95 % CI: 0.02, 0.20; TCS: β = 0.08; 95 % CI: 0.02, 0.14), and peer problems (MeP: β = 0.10; 95 % CI: 0.02, 0.18); however, we did not identify any significant association with conduct problems. Further phenol mixture analyses in the WQS model yielded similar results. Stratification for child sex showed stronger positive associations in boys. ConclusionOur findings indicated that maternal phenol levels during early pregnancy, specifically BP1, TCS, and MeP, are associated with high behavioral problem scores in 4-year-old children.

Factors influencing children's emotional and behavioral problems perceived by North Korean refugee mothers: a descriptive study.

The study investigated the relationships between key variables, including the level of parenting knowledge, acculturative stress, depression, and the strengths and difficulties associated with their children's emotions and behavior, among North Korean refugee mothers who faced the challenging task of adapting to Korean society while raising their children. A descriptive study design was used. Data were collected from 130 North Korean refugee mothers between September and November 2023. The participants had very limited parenting knowledge, and 82.3% of them scored 21 or higher on the depression scale used in community epidemiological studies. Higher levels of parenting knowledge and lower levels of depression were associated with lower levels of acculturative stress. Moreover, higher levels of depression were associated with more emotional and behavioral difficulties in children. Maternal depression, age, and employment status were identified as factors that influenced emotional and behavioral problems in preschool-aged children. These findings underscore the importance of providing parent education and mental health support programs for North Korean refugee families in order to improve parents' parenting skills and emotional well-being.

The Effects of Online Behavioral Parenting Interventions on Child Outcomes, Parenting Ability and Parent Outcomes: A Systematic Review and Meta-analysis

The twenty-first century has seen the development and delivery of online programs of behavioral family intervention for disruptive child behavior. Typically, programs evaluate outcomes in terms of change in child functioning and change in parenting ability. Existing research has also articulated the importance of parent–child relational capacity and its role in facilitating change in child functioning, and the importance of parent emotion regulation in the interests of ensuring optimal child development. These factors were explored in a meta-analysis of k = 14 prospective longitudinal research studies of online parenting interventions for disruptive child behavior. Peer reviewed randomized controlled trials with inactive control groups that were published in English between 2000 and 2022 were included in the review if they were delivered online; offered parent self-directed treatment; included as participants families who were screened as having child behavioral difficulties on validated psychometric assessment measures; and assessed child treatment outcomes, parenting ability and parent treatment outcomes. The protocol for this study was pre-registered with PROSPERO (CRD42020215947). Statistical analyses employed random effects models and reported pooled effect sizes (Hedge’s g) within and between groups. Results emphasize the importance of child outcomes and parenting ability in program assessment, however, suggest that parents’ capacity to develop optimal parent–child relationships and regulate emotion may not be sufficiently reflected in program content. Identified continuous and categorical moderators of treatment outcome were also assessed. Results of the review are discussed in terms of their potential to influence the future development of online programs of behavioral family intervention and, therefore, child development.

Practitioners' experiences of delivering parenting interventions remotely: A mixed‐methods study

AbstractGroup Stepping Stones Triple P (GSSTP), is an evidence‐based intervention for parents of children with intellectual disability that aims to improve child behavioural difficulties. GSSTP was designed to be delivered face‐to‐face, but during the COVID‐19 pandemic some services started delivering it remotely. The evidence base for remote intervention is growing, but few studies have focused on the experiences of practitioners delivering the interventions and the consequences of their service provision. We aimed to explore UK practitioners' experiences of delivering remotely GSSTP. The objectives were to identify the advantages and disadvantages of remote GSSTP, to determine whether adjustments were made to enable delivery, and to assess perceived acceptability. Participants were identified using consecutive sampling from the Triple P UK practitioner network. Eleven practitioners, who had experience of delivering GSSTP remotely and face‐to‐face, reported their experiences in an online survey. Ten participants also took part in semi‐structured interviews. Interviews were transcribed verbatim and analysed using thematic analysis. According to 55% of practitioners, parent attendance had increased with remote delivery, and 73% of practitioners found remote GSSTP equally or more effective than face‐to‐face. Survey findings about managing parent engagement remotely were mixed and building rapport with patients was considered equally or more difficult remotely. The key themes from the thematic analysis were the practitioners' ‘sincere enthusiasm’ over the advantages of the remote GSSTP provision, the ‘person‐centered strategies’ that characterised their practice, the emergence of ‘remote delivery as the way forward’ for parenting services and finally, the ‘challenges of remote delivery’. Remote GSSTP was perceived to be acceptable to participants and practitioners; the advantages of remote delivery appeared to outweigh the disadvantages. Practitioners reported strategies to prompt engagement and recreate group interactions in the remote setting that could be integrated in the practice of other group parenting providers.

Associations between Atopic Dermatitis and Behavior Difficulties in Children.

Background and Objectives: There has been increasing evidence that atopic dermatitis (AD) is associated with behavioral difficulties (BDs). There is currently a lack of evidence of how the severity of the disease determines BDs and what additional factors may contribute to their manifestation. The aim is to determine what kind of BDs occur in children with AD compared to healthy children and to find out what additional factors may contribute to the development of BDs in AD patients. Materials and Methods: This is a cross-sectional, prospective study with the application of a risk assessment instrument for behavior difficulties (Child Behavior Checklist, CBCL 6/18) in pediatric patients with AD and healthy controls (6-17 years) between 1 January 2020 and 31 December 2022. For statistical comparison, mainly Wilcoxon-Mann-Whitney and Student's t-test were used, considering a significance level of 5%. Results: This study included a total of 101 children: 48% with AD, 52% non-AD. The mean age was 10 ± 2.7 years for AD, and10.5 ± 3.1 years for the control patients. AD patients had higher internal behavior scale scores and T-scores (6.6 ± 6.4 vs. 9.6 ± 6.9 and 47.9 ± 9.5 vs. 52.3 ± 10.2, p = 0.01), anxiety/depression scale score and T-score (2.8 ± 2.7 vs. 4.3 ± 3.5 and 47.7 ± 8.4 vs. 52.5 ± 11, p = 0.02), and somatic problems scale score and T-score (2.1 ± 2.3 vs. 3.5 ± 3 and 47.6 ± 8.5 vs. 52.7 ± 10.9, p = 0.005). Patients with severe AD had sleep disturbance and itching scores higher than those with mild-moderate AD (5.4 ± 2.6 vs. 2.4 ± 2.2, p = 0.000 and 6.6 ± 2.4 vs. 4 ± 2.8, p = 0.001). The mean morning serum cortisol concentration was lower in AD patients compared to controls (252.91 ± 304.34 vs. 351.55 ± 126.09 nmol/L, p = 0.047). Conclusions: Children with AD present a higher risk of BDs than healthy controls. Patients with severe AD experience more sleep disturbances and a greater intensity of itching compared to mild-moderate AD. The occurrence of BDs was not related to serum cortisol levels. The cortisol level, severity, age, gender, duration of illness, intensity of pruritus, and sleep disturbance did not affect the development of BDs.