Child Behavior Problems Research Articles

Investigation of the effectiveness of parent-child interaction therapy on adjustment and behavioral problems in children with subthreshold autism

BackgroundAutism Spectrum Disorder (ASD) is an increasingly prevalent neurodevelopmental disorder. However, the number of children who exhibit subthreshold levels of ASD symptoms, significant enough to experience functional and adaptive difficulties, is also substantial. These children require early interventions, similar to those diagnosed with ASD, due to their exhibited adaptive and behavioral challenges. PCIT offers a unique opportunity for children and their parents exhibiting subthreshold ASD to address such challenges through its practices and techniques.AimThis study aims to assess the initial result effectiveness of standard PCIT on the adaptive skills and school refusal behaviors of children exhibiting subthreshold ASD, as well as on the levels of parental stress and caregiving burden. The study intends to test these effects and report the outcomes.MethodThis study is a case study, and it involves three children with subthreshold ASD symptoms and their parents. The therapy processes were conducted for approximately 1 year.ResultResults obtained from this study revealed that PCIT holds promising prospects for improving adaptive and interaction skills, reducing school refusal, and alleviating parental stress and caregiving burden among children exhibiting subthreshold ASD.DiscussionPCIT is considered a functional approach for children and parents demonstrating subthreshold ASD symptoms, besides interventions addressing diagnosed ASD children. It is suggested that future studies should evaluate the effectiveness and sustainability of PCIT through randomized controlled trials in the context of subthreshold ASD.

Hair Cortisol in Young Children with Autism and Their Parents: Associations with Child Mental Health, Eating Behavior and Weight Status.

Children with autism and their parents face daily challenges that may be stressful for both. However, little is known about biological stress (hair cortisol concentrations [HCC]) in these families and its connection to children's health outcomes. This study investigates biological stress in children with autism and their parents and its associations with child mental health, eating behavior and BMI. Stress was measured in 102 young children with autism and their parents (101 mothers, 86 fathers) using HCC and self-reported parenting stress (OBVL). Child mental health was measured through autism symptoms (ADOS-2, SRS-2) and problem behavior (CBCL). Child eating behavior (CEBQ) and BMIz were also measured. Children with autism had higher HCC than their peers. Child HCC was not linked to mental health, eating behavior, or BMIz. Maternal stress (self-reported and HCC) was associated with child problem behavior. In fathers, self-reported parenting stress correlated with child autism symptoms (SRS-2) and behavior problems. Both parents' self-reported stress was associated with child eating behavior, specifically emotional undereating and overeating. In conclusion, higher HCC levels in children with autism in comparison to children from the general population, suggest differences in stress-regulation in children with autism. Given these findings, monitoring HCC in research and clinical practice could improve our understanding of stress-regulation in children with autism. The association between parental stress and children's mental health and eating behaviors, underscores the importance of considering family dynamics in clinical (preventive) interventions and in further research that addresses the mental and physical health of children with autism.

Association Between Maternal Lead Exposure from Seafood Consumption and Neurodevelopment: A Systematic Review.

Despite the essential nutrients, maternal seafood consumption during pregnancy or lactation (PL) is also a potential source of toxins, including lead (Pb). The association between exposure to Pb from seafood during PL on children's neurodevelopment is uncertain. This systematic review assessed the association of exposure to Pb from seafood during PL on children's neurodevelopment. Embase, PubMed, CENTRAL and PsycINFO were searched for English-language peer-reviewed articles. Two independent reviewers screened at title and abstract and full-text levels. Experimental and observational studies comparing different levels of exposure to seafood and Pb were eligible if: 1) the exposed population was healthy pregnant or lactating individuals from high or very high Human Development Index countries; 2) assessed neurodevelopment in children ≤18 years old; and 3) measured maternal seafood intake, Pb exposure and analyzed their relationship with each other and/or their association with child neurodevelopment. The Cochrane ROBINS-E and GRADE tools were used to assess the risk of bias and certainty of evidence. Four included articles from three prospective cohort studies in Asia examined cognition, motor development, and behavior in children 12-60 months. Only one study reported an analysis between seafood intake and lead concentrations during PL which showed a weak, insignificant association. Pb concentrations were not associated with child cognitive development or behavioral problems, but a weak, negative association with child motor development was reported. The certainty of evidence was very low due to few included studies with some or high risk of bias. Higher seafood intake in this evidence favored positive developmental outcomes from one prospective cohort study, though significance varied. Overall, evidence was not available to address a direct association between Pb exposure from seafood intake during PL and child neurodevelopment. Several other limitations resulted in a very low certainty of overall evidence. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: This systematic review protocol was registered in PROSPERO (CRD42023494884).

Relationship between parenting stress and behavioral and emotional problems in preschool children: A mediation effect analysis.

Emotional reactions, such as anxiety, irritability, and aggressive behavior, have attracted clinical attention as behavioral and emotional problems in preschool-age children. To investigate the current status of family rearing, parental stress, and behavioral and emotional problems of preschool children and to analyze the mediating effect of the current status of family rearing on parental stress and behavioral/emotional problems. We use convenience sampling to select 258 preschool children in the physical examination center of our hospital from October 2021 to September 2023. The children and their parents were evaluated using a questionnaire survey. Pearson's correlation was used to analyze the correlation between child behavioral and emotional problems and parental stress and family rearing, and the structural equation model was constructed to test the mediating effect. The score for behavioral/emotional problems of 258 preschool children was (27.54 ± 3.63), the score for parental stress was (87.64 ± 11.34), and the score for parental family rearing was (31.54 ± 5.24). There was a positive correlation between the behavioral and emotional problems of the children and the "hostile/mandatory" parenting style; meanwhile, showed a negative correlation with the "support/ participation" parenting style (all P < 0.05). The intermediary effect value between the family upbringing of parents in parental stress and children's behavior problems was 29.89%. Parental family upbringing has a mediating effect between parental stress and behavioral and emotional problems of children. Despite paying attention to the behavioral and emotional problems of preschool-age children, clinical medical staff should provide correct and reasonable parenting advice to their parents to promote the mental health of preschool-age children.

'Let the System Do Its Job and Families Handle the Rest'? Protective and Risk Factors Contributing to Pandemic Crisis Parental Burnout.

Background: The work main purposes were to identify the sources of problems and demands causing parental burnout and to specify the resources/support factors during the COVID-19 pandemic. The study was based on the Balance Theory of Risk and Support/Resource Factors (BR2 Model) by Mikolajczak and Roskam. Methods: The study explored the predictive value of socio-economic variables, religiosity, the meaning of life, positivity, perceived social support, family functionality, and balance between risks and resources in parental burnout using the structural equation modelling method on a sample of 337 parents. Results: The presence of children's learning difficulties and behavioural problems are the most important risk factors and aggravate parental burnout, and the presence of a meaning of life, support coming from the family, family affection, and relationship lengths are the main protective resources, allowing parental burnout to decrease during the pandemic crisis. Conclusions: The findings are instructive for both theory and practice. The study successfully operationalised the BR2 model-the model obtained from the path analysis fits well, confirms the structure of parental burnout theory, and demonstrates the appropriateness of the application of BR2 theory in crisis conditions. The most effective way to help parents in a crisis situation is (in addition to psychological support) the effective provision of specialist help for children, resulting in a reduced risk of an unfavourable balance between demands and family resources. The family- or parent-oriented interventions that address professional help in problems with children can be the most effective at reducing the negative consequences of a pandemic on children and their parents. The COVID-19 pandemic has shown the importance of investing in healthcare infrastructures.

Heat Exposure Predicts Earlier Childhood Pubertal Initiation, Behavioral Problems, and Tobacco Use

Heat Exposure Predicts Earlier Childhood Pubertal Initiation, Behavioral Problems, and Tobacco Use

Parent-focused online video intervention for promoting parenting sense of competence: a randomized controlled trial.

Apart from child behavioral problems which were ameliorated by increasing parenting skills, parental well-being is one of the important components for development of parenting sense of competence (PSOC), which subsequently affects parenting style and child outcomes. This randomized controlled trial study aims to determine whether a brief asynchronous parent-focused online video intervention (POVI) that was easily accessible would be effective in increasing PSOC and parental well-being. One hundred and twenty parents, with a poor Thai Mental Health Indicators-15 score or mild-moderate depression/anxiety, of children aged 3-10 years, were randomized into two parallel groups, intervention and control groups (1:1). The intervention group received six online, weekly, parent-focused sessions. Parent and child outcomes were measured at baseline, 6, and 10 weeks. The Generalized Estimating Equations model was used for the analysis. At 10 weeks, the intervention group reported a higher PSOC (p = 0.005), particularly on the parenting satisfaction subscale, and mental health indicator. Both groups experienced reduced depression and anxiety from baseline, and child behaviors remained unchanged. POVI improved PSOC and parental well-being among parents with mild to moderate mental health problems. POVI may be used as a primary tool to promote parental well-being in general pediatric practice. This study demonstrates the efficacy of a parent-focused online video intervention (POVI) in enhancing parenting sense of competence and parental well-being. It addresses the gap in interventions that focus primarily on parental well-being, particularly for those who face mild to moderate mental health challenges. The findings contribute valuable insights for healthcare professionals, highlighting the potential of POVI, an easy-to-access and less time-consuming intervention, as a primary tool to promote parental well-being in general pediatric practice settings.

Development and Validation of Child Observation Checklist for Early Screening of Young Children with Special Needs.

Background: Families with young children with developmental disabilities often express concerns about delays in the identification of these and extended waiting times for obtaining assessments, learning support, and rehabilitation services. The identification process must and can be enhanced if preschool teachers have instrumental measures to detect early-stage developmental disabilities and adjustment difficulties in preschool children and, if necessary, to provide these children with prompt and effective support services. Aims: The aim with this study was to develop and validate a screening checklist for teachers to detect developmental delays and adjustment difficulties in Chinese preschool children in Hong Kong. Methods: The participants included 1085 children aged two to six years (including 365 children who were receiving rehabilitation services at the time of the study) and their preschool teachers. The teachers were requested to complete the screening checklist and the Strengths and Difficulties Questionnaire. Results: The results of the Rasch and Confirmatory Factor Analyses supported the unidimensionality of the checklist, with the validated version consisting of fifteen items and five factors. The checklist score was negatively correlated with children's behavioral problems and effectively differentiated children of different ages and between children receiving and not receiving rehabilitation services. The reliability estimates (internal consistency and test-retest) of this revised checklist were above 0.70. Conclusions: The 15-item checklist is a promising screening instrument for the identification of developmental disabilities and adjustment problems among Chinese preschool children. The use of the checklist has accelerated access to rehabilitation services for children and family caregivers.

Dyadic resilience after postpartum depression: The protective role of mother-infant respiratory sinus arrhythmia synchrony during play for maternal and child mental health across early childhood.

Coordination in mothers' and their infants' parasympathetic nervous system functioning (i.e., respiratory sinus arrhythmia [RSA] synchrony) specifically during playful interactions may promote resilience against exposure to postpartum depressive symptoms (PPD), for both members of the dyad. To test biobehavioral synchrony theory-derived hypotheses, we evaluated whether positive mother-infant RSA synchrony during play attenuated associations between maternal PPD symptoms and future child behavior problems and maternal depressive symptoms. 322 low-income, Mexican-origin mothers and their children participated in 5-min resting baseline and free play interaction tasks when children were 24 weeks of age; mothers reported on their PPD symptoms and on child behavior problems and maternal depressive symptoms at 12- and 36-months child age. Results of multilevel structural equation models demonstrated that, though the associations between maternal PPD symptoms and future child behavior problems and maternal depressive symptoms differed depending on levels of RSA synchrony during play and non-interactive tasks, the protective benefits of positive RSA synchrony on 12-month maternal depressive symptoms and 36-month child internalizing problems were specific to its assessment during a playful interaction. Results suggest that the dyadic coordination of physiological capacities during playful interactions is an active mechanism that promotes resilience to emotional distress for mothers and their children.

Effects of the Early Start Denver Model on emotional dysregulation and behavior problems in children with Autism spectrum disorder

BackgroundMost previous studies have focused on the clinical efficacy after intervention of ESDM, particularly in core symptoms. However, only a few have paid attention to the effectiveness of ESDM on emotional dysregulation and behavior problems in children with ASD. This study aimed to explore the effect of the ESDM on addressing emotional dysregulation and behavior problems in children with ASD in China, as well as its correlation with core symptoms of ASD.MethodsA total of 319 children aged 1.5 to 5 years were included in this study and received treatment based on the ESDM intervention program Baseline assessment (T0) was conducted before intervention, including Children Behavior Checklist (CBCL), Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS). All children with ASD were examined in the assessment (T1) after 12 weeks of treatment. Emotional dysregulation and behavior problems in children with ASD were measured using CBCL, while ABC and CARS were used to evaluate the core symptoms.ResultsIn the T1 assessment, the core symptoms of children with ASD in ABC and CARS showed significant differences. Subscale scores of ABC and the severity of CARS, including senses, relationships, stereotypes objects to use, self-help and social also exhibited significant differences. The children showed significant differences in both total score and subscale scores of CBCL(P < 0.05), which included emotionally/reactive, anxious/depressed, somatic complaints, withdrawal, sleep problems, attention problems, aggressive behavior, internalization and externalization. The children demonstrated significant differences in scores of CBCL-AAA (P < 0.05), taking into account the combined total of attention, aggression and anxious/depressed CBCL T scores. In addition, a consistent positive correlation was observed between the overall scores of CBCL and the core symptoms of children with ASD as indicated by ABC and CARS in both T0 and T1(P < 0.01). In T0, the CBCL-AAA scores were positively associated with the core symptoms of children with ASD as reflected by CARS(P < 0.01), as well as senses of ABC( P < 0.05). During T1, a noteworthy significant positive correlation was observed between the CBCL-AAA scores and the core symptoms of children with ASD as indicated by both ABC and CARS assessment (P < 0.05).ConclusionsChildren with ASD benefit from ESDM, not only in terms of improving their core symptoms, but also in terms of improving their emotional dysregulation and behavior problems, and ESDM could be considered as one of the early treatment options for overall psychological promotion. The core symptoms of children with ASD are significantly associated with emotional dysregulation and behavior problems in young children, both cross-sectionally and prospectively for the short term over time. Emotional dysregulation and behavior problems represent an important comorbidity, and could be considered as potential treatment targets for treatment for improving emotional stability in ASD.

Family functioning as a mediator or moderator between child behavioural and emotional problems and maternal psychological distress

ABSTRACT Background Mothers of children with intellectual disabilities are more likely to show elevated psychological distress, with child behavioural and emotional problems being a significant risk factor. Family Resilience Theory suggests that family relationships are crucial in influencing adaptation to stressors. We investigated whether family functioning mediates or moderates the relationship between child behavioural and emotional problems and subsequent maternal psychological distress. Method We conducted mediation and moderation analyses on data from 324 mothers of children with intellectual disabilities in a United Kingdom (UK) prospective longitudinal cohort study. Results Family functioning had a small mediating effect on the relationship between child behavioural and emotional problems and subsequent maternal psychological distress. Family functioning did not moderate the relationship between child behavioural and emotional problems and later maternal psychological distress. Conclusions The mechanism of the effect of child behavioural and emotional problems on maternal mental health may at least partially involve changes in family functioning.

How does family functioning contribute to child externalizing and internalizing behavior problems after childhood TBI? Evidence from a prospective cohort study.

Despite a well-documented association between childhood traumatic brain injury and elevated risk for internalizing and externalizing behavior problems, the mechanisms through which family functioning contributes to individual variation in these behavioral outcomes remains poorly understood. This prospective cohort study aimed to assess the respective contribution of family functioning and child emotion regulation (ER) to post-injury behavior problems at 1-year follow-up, with a specific focus on evaluating the role of emotional dysregulation in mediating the effects of familial affective responsiveness and communication on child behavioral outcomes. The study included 129 participants, comprising 86 children with medically confirmed mild-to-severe TBI, identified from consecutive hospital admissions, and 43 typically developing (TD) control children, of similar age and sex. Participants ranged in age from 6 to 15 years (mean age = 11.2 years). Parents completed validated assessments of post-acute family functioning and child emotion regulation difficulties at 6 months post-injury, as well as measures of child behavior problems at 1-year post-injury. Although group differences in internalizing behaviors did not reach statistical significance, the TBI group exhibited significantly higher overall externalizing symptoms and was significantly more likely to display clinically elevated symptoms than TD controls at 1-year post-injury. Compared to TD controls, the TBI group displayed significantly greater ER problems, which mediated the effects of lower familial affective responsiveness and communication on child behavior problems 1-year-post-injury. Evidence for these robust, prospective associations suggests that child emotional dysregulation plays a key role in mediating the effect of post-acute family functioning on long-term behavior problems in children with TBI. Early assessment and screening for relevant risk factors may help identify those children and families who could benefit from therapeutic interventions designed to address emotional dysregulation and mitigate risk for post-injury behavioral problems. Importantly, these findings underscore the value of adopting family-centred care approaches in rehabilitation, where involving families in therapeutic processes and addressing family dynamics may enhance child emotion regulation and improve long-term behavioral outcomes.

Mediating Role of Parent-Child Conflict in the Association Between Parental Anxiety and Emotional Behavioral Problems Among Children With Leukemia.

There is a documented risk of emotional and behavioral disorders in children with leukemia. Assessing the factors contributing to their behavioral disorders is particularly important from a prevention perspective. The aim of this study was to study the influencing factors of internalizing and externalizing behaviors in children with leukemia from the perspective of adult family members. Cluster sampling was utilized to recruit a sample of 219 children diagnosed with leukemia. The caregivers of these children completed assessments on parental anxiety, parent-child conflict, and internalizing and externalizing child behavior problems. Study findings indicate that children diagnosed with leukemia exhibit significant internalizing and externalizing behavior problems. Parental anxiety has a positive direct impact on both the internalizing and externalizing behavioral difficulties experienced by their children. Furthermore, parental anxiety indirectly influences the occurrence of internalizing and externalizing behavior problems through parent-child conflict. Findings underscore the potential for enhancing the parent-child relationship as a means to mitigate children's internalizing and externalizing problems by reducing parent-child conflict and parental anxiety. The child and family-centered care approach in pediatric nursing is fundamental in assessing and addressing the needs of the child and family. To ameliorate emotional behavior issues in children with leukemia, the quality of the parent-child relationship needs to be considered as a pivotal component of family-based interventions and clinical practice.

아동그룹홈 시설장의 시설경영 인식에 관한 포토보이스 연구

This study utilized the Photovoice method to analyze the managerial perceptions and experiences of children's group home facility managers, exploring operational issues and improvement strategies. The study involved five female managers with an average of 10 years of experience, and data were collected through pre-group and individual interviews conducted from January to March 2023. The results identified major operational issues such as children's maladjusrment and behavioral problems, conflicts with biological families, and conflicts among staff members. Additionally, excessive workloads and staff shortages emerged as ongoing challenges that negatively impact the efficiency of group homes and child welfare. These issues were found to hinder the primary functions of group homes and the healthy growth and development of children. Based on these findings, the study proposed policy recommendations to improve the group home system. These recommendations aim to enhance child protection systems, improve the qualiry of internal programs, increase operational efficiency, and promote child welfare. Furthermore, the study sought to understand the difficulties faced by managers and staff members in group homes and provide specific solutions to address these challenges, thereby fostering the overall development of the group home system. The study's limitations include the small number of participants and the restricted regional scope. Future research should expand the study's scope to include managers from diverse backgrounds and delve deeper into various aspects of group home operations. 1his research is expected to make a significant contribution to solving practical problems in group homes and developing effective measures for child protection.

Externalizing Problems in Children: Examining the Role of Caregiver and Child Adversities and Parental Involvement

Previous research has shown that exposure to adverse childhood experiences (ACEs) is associated with increased behavior problems in children. Few studies, however, have taken a multi-informant approach to examine how different factors involving both the child and caregiver affect children’s externalizing problems. Guided by Bowen’s Family Systems Theory, the current study examined how child age and gender, caregiver age, household income, child and caregiver adversity, and child and caregiver report of caregiver involvement were associated with children’s externalizing problems. The sample included 65 caregiver-child dyads recruited from community programs in the Midsouth, United States. Youth were aged 6-12 years and primarily identified as Black or African American (95.45%) and as boys (54.55%). Two linear regression models were run with caregiver-report of child externalizing problems as the dependent variable in both models. One model focused on child variables, including child age, child gender, child adversity, and child-report of parental involvement, while the other centered caregiver variables, including caregiver age, income, caregiver ACEs, and caregiver report of their own parental involvement. Only the caregiver model was significant, with more caregiver ACEs related to higher child externalizing problems. None of the other independent variables were related to child externalizing problems. These results demonstrate the impact of caregiver’s history of adversity on child functioning. Interventions that target children’s externalizing problems may benefit from incorporating an assessment of parent adversity history. Future research should explore underlying mechanisms that may explain this association to identify modifiable factors that could be included in treatments for youth experiencing externalizing problems. KEYWORDS: Intergenerational; Behavior Problems; Adverse Childhood Experiences; ACEs; Caregiver-child Dyads; Youth Functioning; Family Systems; Multi-informant

Parental Burnout in Israeli Parents of Children with ASD During Wartime: The Role of Child Behavior, Parental Emotion Regulation, Stress, and Social Support.

During emergencies like wartime, parents of children with Autism Spectrum Disorder (ASD) face heightened challenges, potentially leading to Parental Burnout (PB). Wartime conditions can exacerbate children's behavioral difficulties, contributing to PB. Protective factors such as successful Emotional Regulation (ER) and perceived social support may mitigate PB. This study aims to compare child behavioral problems, parental ER difficulties, perceived social support, stress, and PB between parents of children with ASD and Typical Development (TD) during wartime. It also investigates how ER difficulties, perceived social support, and stress moderate the relationship between child behavioral problems and PB. The study included 213 Israeli parents: 101 parents of children diagnosed with ASD and 112 parents of TD children. Participants were recruited during the "Swords of Iron" War using purposive sampling via online platforms. Findings indicate that children with ASD exhibited higher levels of behavioral problems, and their parents experienced increased difficulties in ER, stress, and PB, alongside decreased perceived social support compared to parents of TD children. Moderation analysis revealed that ER difficulties, perceived social support, and stress moderated the direct association between child behavioral problems and PB specifically among parents of TD children. This study underscores the heightened vulnerability of parents with ASD-diagnosed children during wartime, emphasizing the importance of understanding how these circumstances impact parental well-being and available resources. Effective interventions should target enhancing ER, social support, and addressing parental stress, PB, and child behavioral issues, underscoring the need for prioritized services despite wartime challenges.

Resilience in Families of Autistic Children and Children With Intellectual Disability During the COVID-19 Pandemic.

Resilience in families of autistic children and children with intellectual disability is associated with factors such as family functioning, social support, and financial strain. Little is known about family resilience during the COVID-19 pandemic when many resources were limited. This study examined the association of family resilience with child characteristics, family resources, and socioecological factors during the pandemic. Data collected during the COVID-19 pandemic from 734 United Kingdom parents/caregivers of children who are autistic and/or have intellectual disability were analyzed using path analysis. Greater family resilience was significantly associated with fewer child behavior problems, absence of intellectual disability, higher financial status, and greater family functioning, though not school support. These factors might guide future research and practices to support vulnerable families at risk of low resilience.

Behavioral problems in children with unoperated rheumatic heart disease at national referral hospital in Ethiopia: an observational study

BackgroundThe behavioral disorder is characterized by a profound abnormality in an individual’s cognition, emotion or behavior that reflects in psychological, biological or developmental dysfunction. Rheumatic heart disease (RHD) is a long-term sequel of single or recurrent acute rheumatic fever. Children with RHD are thought to be at increased risk for behavioral problems due to autoimmunity seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Behavior disorder is not well studied among children with RHD. Hence, this study aimed to assess the pattern and predictors of behavioral problems among children with RHD enrolled in chronic care at a national cardiac referral Hospital.MethodsThis cross-sectional study used a validated parental-reported Amharic Strengths and Difficulties Questionnaire (SDQ) to assess behavior problems. Children with RHD aged 6–17 years on chronic outpatient cardiac care at Tikur Anbessa Specialized Hospital, Ethiopia between February and May 2023 were included. Factors associated with behavior problems were assessed using logistic regression models.ResultsThe study included 166 children with a median age of 15 years [Interquartile range (IQR):13–17 years]. One-fourth of children, 24.7% (95% CI: 18.34–31.98), had behavioral problems. Of these, 46.4% (77) emotional, 35.5% (59) peer, 18.1% (30) conduct and 6.6% (11) hyperactivity problems were documented. Children who had good medication adherence, adjusted odds ratio AOR 0.29(95% CI: 0.09–0.94, P 0.040) and on New York Health Association (NYHA) class I, AOR 0.28(95% CI: 0.11–0.79, P 0.016) had lower odds for behavioral problems.ConclusionOne-fourth of children with RHD had behavioral abnormalities. Medication adherence and NYHA predicted behavioral abnormality. Better physical symptom control was associated with fewer behavioral problems. Behavioral abnormalities should be considered and assessed among children with RHD. Further multi-center mixed studies are recommended to uncover the unseen behavioral problem and guide health policy action on modalities of integration of behavioral problems assessment tools in clinical care.

Reciprocal associations between child disclosure, parental solicitation, and behavior problems during middle childhood

Parental knowledge is often the result of parents soliciting information from their child and their child’s disclosure of that information. Although child disclosure is most closely (and negatively) associated with behavior problems in adolescence, it is not yet known whether this is also the case in childhood. The aim of this study was to examine the longitudinal associations between child disclosure, parental solicitation, and behavior problems in Grades 1 to 4 in a Canadian sample, taking into account intra-individual stability, the child’s gender, and socioeconomic status. The mothers and teachers of 911 children (62.7% boys) completed questionnaires in Grades 1, 2, 3, and 4. A Random Intercept Cross-Lagged Panel Model (RI-CLPM) showed that behavior problems in Grade 2 predicted an increase in parental solicitation in Grade 3. In contrast, behavior problems in Grade 3 predicted a decrease in parental solicitation in Grade 4. No cross-lagged association with child disclosure was observed. Although these results differ from those reported in adolescence, they suggest that middle childhood is a sensitive period for parent–child communication and behavior problems.

Identifying Active Ingredients that Cause Change in Digital Parent Training Programs for Child Behavior Problems: A Qualitative Exploration.

Digital parent training programs (DPTs) aimed at treating child behavior problems have shown efficacy in a number of trials, but less is known about the active ingredients parents find helpful while using DPTs. We analyzed data from users of self-guided DPTs within a randomized controlled trial setting: a standard program (DPT-STD) and an enhanced program (DPT-TP). Thematic analysis of interviews (n = 16) reveals that users of both programs endorsed the "content", "content presentation", "accessibility", and "therapeutic context" as beneficial. However, only DPT-TP users identified the "therapeutic persuasiveness" as helpful, attributing this to features embedded exclusively in the enhanced program, including call-to-action reminders and assessment-based feedback. Findings were reinforced by the analysis of responses to open-ended questions from a larger sample of users (n = 31 DPT-STD users and n = 34 DPT-TP users). These findings underscore the importance of utilizing features that help parents make positive changes in their home.