Children's Externalizing Behavior Problems Research Articles

Origins of children's externalizing behavior problems in low-income families: toddlers' willing stance toward their mothers as the missing link.

Although children's active role in socialization has been long acknowledged, relevant research has typically focused on children's difficult temperament or negative behaviors that elicit coercive and adversarial processes, largely overlooking their capacity to act as positive, willing, even enthusiastic, active socialization agents. We studied the willing, receptive stance toward their mothers in a low-income sample of 186 children who were 24 to 44 months old. Confirmatory factor analysis supported a latent construct of willing stance, manifested as children's responsiveness to mothers in naturalistic interactions, responsive imitation in teaching contexts, and committed compliance with maternal prohibitions, all observed in the laboratory. Structural equation modeling analyses confirmed that ecological adversity undermined maternal responsiveness, and responsiveness, in turn, was linked to children's willing stance. A compromised willing stance predicted externalizing behavior problems, assessed 10 months later, and fully mediated the links between maternal responsiveness and those outcomes. Ecological adversity had a direct, unmediated effect on internalizing behavior problems. Considering children's active role as willing, receptive agents capable of embracing parental influence can lead to a more complete understanding of detrimental mechanisms that link ecological adversity with antisocial developmental pathways. It can also inform research on the normative socialization process, consistent with the objectives of developmental psychopathology.

Long-Term Relationships among Domestic Violence, Maternal Mental Health and Parenting, and Preschool Children's Behavior Problems

Using 4 waves of a longitudinal dataset, this study tested whether maternal mental health and parenting at Year 3 mediate the effects of domestic violence at Year 1 on preschool children's internalizing or externalizing behavior problems at Year 5. After controlling for preexisting child effects and parenting stress, structural equation models revealed that maternal mental health mediated the effects of domestic violence for children's externalizing behavior problems. Parenting, specifically spanking, mediated those effects for both behavior problems of children. Domestic violence had direct effects on both types of behavior problems of children. These findings highlight the long-term effects of domestic violence on preschool children and the need for early intervention and prevention efforts for the children in violent families.

Psychological distress in African American grandmothers raising grandchildren: The contribution of child behavior problems, physical health, and family resources

Diminished psychological health has been identified among caregiving grandmothers. The intent of this investigation was to examine psychological distress levels, as well as their predictors, in a sample of 480 caregiving African American grandmothers, mean age 56 years. Almost 40% (39.8%) of participants had clinically elevated psychological distress scores. Results of hierarchical multiple regression indicated that internalizing and externalizing child behavior problems, poor grandmother physical health, younger age of grandmother, and lack of family resources predicted 31% of the variance in psychological distress. Results provide direction for nursing interventions aimed at enhancing the psychological well-being of caregiving grandmothers.

Maternal distress influences young children's family representations through maternal view of child behavior and parent-child interactions.

Distress of a parent is a key influence on the quality of the child's experience in the family. We hypothesized that maternal distress would spill over into more negative views of their children's behaviors and less emotional availability in their relationships. Further, we investigated whether these cumulative experiences contributed to children's emerging narratives about mothers and family life. In this longitudinal study, mothers of young twin children reported their distress on three occasions in relation to: self, the marital relationship, and the family climate. Mothers also reported on their children's externalizing behavior problems. Mother-child interaction was observed focusing on maternal sensitivity and child responsivity. Children responded to story stem beginnings about challenging situations in the family and their narratives were scored for family conflict and cohesion themes. Actor-partner interdependence model methods of dyadic data analysis accounted for the inclusion of both twins in the analysis. Results from structural equation models supported the hypothesized cumulative experience of maternal distress on children's family life representations for both family conflict and family cohesion. A family environment in which children are exposed to persistent maternal distress early in life may have cumulative effects, influencing how mothers interact with and view their children's behavior at later developmental stages. Moreover, exposure to repeated distress for longer periods of time may contribute to an intergenerational continuity of distress for the child that may become rooted in negative affective bias in their own view of family relationships.

Resolution of Intimate Partner Violence and Child Behavior Problems After Investigation for Suspected Child Maltreatment

OBJECTIVE To describe longitudinal change in child behavior problems associated with resolution of intimate partner violence (IPV) after an investigation for suspected child maltreatment. DESIGN Retrospective cohort study. SETTING The National Survey of Child and Adolescent Well-Being, a nationally representative longitudinal sample of US households investigated for suspected child maltreatment. PARTICIPANTS The study included 320 school-aged subjects with caregiver-reported IPV in the year prior to baseline interview. Caregivers were interviewed an average of 3, 20, 36, and 81 months following investigation. MAIN EXPOSURE Resolution vs persistence of baseline IPV. Persistence was defined by report of IPV during any follow-up interview. MAIN OUTCOME MEASURES Clinically significant internalizing or externalizing child behavior problems. RESULTS In total, 44.6% of caregivers who reported IPV at the baseline interview reported persistent IPV. After adjusting for significant covariates, IPV resolution was associated with an 11.9% reduction in internalizing problems by 81 months (P=.03); IPV persistence was associated with persistence in baseline problems. Resolution of IPV was associated with an 18.5% reduction in externalizing problems by 20 months that was sustained at 36 and 81 months (all P<.05). Intimate partner violence persistence was associated with a steady but nonsignificant increase in externalizing behavior problems during 81 months (10.1%, P=.07). The adjusted relative risks for internalizing and externalizing behavior problems 81 months following a child protective services investigation for children exposed to persistent vs resolved IPV were 1.79 (95% CI, 0.91-3.52) and 1.88 (95% CI, 1.12-3.18), respectively. CONCLUSIONS Resolution of IPV after a child protective services investigation for suspected child maltreatment is associated with meaningful, sustained reductions in clinically significant child behavior problems.

Does a booster intervention augment the preventive effects of an abbreviated version of the coping power program for aggressive children?

Booster interventions have been presumed to be important methods for maintaining the effects of evidence-based programs for children with behavioral problems, but there has been remarkably little empirical attention to this assumption. The present study examines the effect of a child-oriented booster preventive intervention with children who had previously received an abbreviated version (24 child sessions, 10 parent sessions) of the Coping Power targeted prevention program. Two hundred and forty-one children (152 boys, 89 girls) were screened as having moderate to high levels of aggressive behavior in 4th grade, then half were randomly assigned to receive the abbreviated Coping Power program in 5th grade, and half of the preventive intervention children were then randomly assigned to a Booster condition in 6th grade. The Booster sessions consisted of brief monthly individual contacts, and were primarily with the children. Five assessments across 4years were collected from teachers, providing a three-year follow-up for all children who participated in the project. Results indicated that the abbreviated Coping Power program (one-third shorter than the full intervention) had long-term effects in reducing children's externalizing problem behaviors, proactive and reactive aggression, impulsivity traits and callous-unemotional traits. The Booster intervention did not augment these prevention effects. These findings indicate that a briefer and more readily disseminated form of an evidence-based targeted preventive intervention was effective. The findings have potential implications for policy and guidelines about possible intervention length and booster interventions.

Working alliance and treatment fidelity as predictors of externalizing problem behaviors in parent management training.

The study investigated treatment fidelity and working alliance in the Parent Management Training-Oregon model (PMTO) and investigated how these relate to children's externalizing problem behaviors, as reported by parents and teachers. Participants were 331 Norwegian parents who rated the client-therapist working alliance at 3 time points (Sessions 3, 12, and 20). Competent adherence to the PMTO treatment protocol was assessed by PMTO specialists from evaluations of videotaped therapy sessions using the Fidelity of Implementation (FIMP) system (Knutson, Forgatch, & Rains, 2003). Parents and teachers reported children's problem behaviors at baseline and at the end of therapy. Structural equation modeling was used to analyze the repeated measures data. Parents reported high and stable levels of alliance and fidelity from Time 1 to Time 3, with no correlational or direct relations between the 2. Treatment fidelity predicted reductions in parent-reported externalizing behavior, whereas working alliance was related to less change in problem behavior. Alliance and fidelity were unrelated to teacher-reported behavior problems. The findings point to treatment fidelity as an active ingredient in PMTO and working alliance as a negative predictor of postassessment parent-reported externalizing behavior. More research is needed to investigate whether these findings can be replicated and extended beyond PMTO.

Child neglect and the development of externalizing behavior problems: associations with maternal drug dependence and neighborhood crime.

Given the high prevalence of child neglect among maltreatment subtypes, and its association with exposure to additional environmental adversity, understanding the processes that potentiate child neglect and link neglect to subsequent child externalizing psychopathology may shed light on key targets for preventive intervention. Among 170 urban low-income children (ages 4-9) and their mothers, this 5-year prospective study examined the effects of early neglect severity and maternal substance abuse, as well as neighborhood crime, on children's later externalizing behavior problems. Severity of child neglect (up to age 6 years) mediated the relation between maternal drug dependence diagnosis (MDDD), determined at children's age of 4 years, and children's externalizing behavior problems at age 9. Rates of neighborhood crime mediated the link between presence of child neglect and children's externalizing behavior problems. The roles of MDDD, child neglect, and community violence in the development of child psychopathology are discussed in terms of their implications for intervention.

Moderators of the Relationship Between Maternal Substance Abuse Symptoms and Preschool Children’s Behavioral Outcomes

While maternal substance use problems increase the likelihood of behavior problems in children, child outcomes are varied, leading to interest in understanding additional family factors that contribute to the development of behavior problems in children impacted by maternal substance abuse. The purpose of this study is to examine harsh parenting and family conflict as potential moderators of the relationship between symptoms of maternal substance use problems and child externalizing behavior problems. The non-clinical sample for this study included 250 low-income parents whose preschool age children were enrolled in Head Start programs in a Southern state. This study utilized data collected during two home visits, an average of 10 months apart, with data on family functioning and maternal symptoms of substance use problems collected at the first time point and child externalizing behavior collected at the second time point. Over one-third of the children (38.1 %) had clinically elevated externalizing behavior scores. We used regression analysis to examine whether harsh parenting or family conflict moderated the relationship between maternal substance use symptoms and child externalizing behavior. In this community sample, we found that in the absence of family risks related to harsh parenting and family conflict, maternal symptoms of substance use problems did not have a significant impact on child externalizing behavior in preschool children. However, when high levels of family conflict or harsh parenting were present, symptoms of maternal substance use problems increased the risk of externalizing behavior problems in children.

Pediatric obsessive compulsive disorder: Family climate as a predictor of treatment outcome

BackgroundMaternal Expressed Emotion (EE) is a poor prognostic indicator for multiple forms of child and adolescent psychopathology; however, there has been relatively little examination of its role in pediatric obsessive compulsive disorder (OCD). This study examined rates of high maternal EE in pediatric OCD, their cross-sectional parent and child correlates, and links to treatment outcome. MethodsParticipants included 58 youths (mean age=12.33 years; % male=59%) participating in a larger randomized control trial comparing family focused cognitive behavior therapy (FCBT) to psychoeducation and relaxation training (PRT) for pediatric OCD. Baseline measures of maternal EE were obtained using the Five-Minute Speech Sample (FMSS). Clinical outcomes were evaluated by independent evaluators using the Clinician's Global Impressions-Improvement Scale (CGI-I). ResultsOverall, 55% of mothers in this sample were rated high EE. High maternal EE at baseline was a significant predictor of poor treatment outcome, X2 (1, n=58)=5.32, p=.02. At baseline high EE was not related to child's OCD symptom severity, but was significantly associated with higher rates of comorbid child externalizing behavior problems and higher levels of parental depressive symptoms. Of the two dimensions of EE, maternal criticism correlated with parental blame and personal responsibility, whereas emotional over-involvement correlated with parental anxiety, depression, and OCD. ConclusionsThese results underscore the significance of family stress, as expressed in high-EE, as a predictor of poor treatment response among youths suffering from OCD.

Longitudinal Experiences of Children Remaining at Home after a First-Time Investigation for Suspected Maltreatment

To describe longitudinal change in risk for children remaining at home following a first-time investigation for suspected maltreatment. A retrospective cohort study of children remaining at home following first-time investigation for maltreatment using a nationally representative sample of households involved with Child Protective Services. Outcomes include poverty, social support, caregiver depression, intimate partner violence (IPV), drug/alcohol dependence, corporal punishment, and child behavior problems at baseline, 18, and 36 months following first-time Child Protective Services investigation. We present longitudinal models to (1) estimate prevalence of risk factors at each timepoint; and (2) examine associations between risk-specific service referrals and longitudinal change in risk factor prevalence. Our sample represented 1057056 US children remaining at home following first-time investigation for maltreatment. Almost 100000 (9.2%) children experienced out-of-home placement within 36 months. The prevalence of poverty (44.3%), poor social support (36.3%), caregiver depression (24.4%), IPV (22.1%), and internalizing (30.0%) and externalizing (35.8%) child behavior problems was above general population prevalence at baseline and remained high over the next 36 months. Referral to risk-specific services occurred in a minority of cases, but was associated with significant longitudinal reductions in IPV, drug/alcohol dependence, and externalizing child behavior problems. Children remaining at home following a first-time investigation for maltreatment live with persistent risk factors for repeat maltreatment. Appropriate service referrals are uncommon, but may be associated with meaningful reduction in risk over time. Pediatricians and policy makers may be able to improve outcomes in these families with appropriate service provision and referrals.

Rationale and modifications for implementing parent-child interaction therapy with rural Appalachian parents.

This article describes the rationale and modifications for implementing parent-child interaction therapy (PCIT) with rural Appalachian parents. (PCIT) is an intervention designed for parents with children ages two through six who exhibit emotional and behavioral issues. PCIT differs from other behavioral programs in that both the child and parent are directly involved in treatment, parents are coached in their use of parenting skills directly during session, and homework assignments are given to build upon gains made in session. PCIT first seeks to rebuild the parent-child relationship through the development of a secure attachment and then integrates discipline to decrease behavioral problems and increase positive child behaviors. This is done through the use of two separate segments: Child-directed interaction (CDI), which aims to increase parental praise, reflection, description, and imitation of child behaviors, and enthusiasm, with the goal of forming a secure attachment between the child and parent, and parent-directed interaction (PDI), in which child behavioral problems are addressed by providing parents with the education and skills (e.g., time-out) necessary to increase child compliance and decrease problem behaviors. Topics discussed include (1) barriers to treatment, (2) externalizing child behavior problems, (3) behavioral parent training programs, (4) cultural modifications to PCIT, (5) alignment of PCIT with Appalachian culture, (6) and Appalachian cultural modifications to PCIT. Language: en

Maternal psychosocial factors around delivery, and the behavior of 2‐year‐old children

The objectives of the present study were to explore whether maternal psychosocial factors, mental health and work stress around delivery, are related to the behavior of 2-year-old children. In a prospective cohort study design, pregnant women attending the National Taiwan University Hospital for delivery and post-partum care from April 2004 to January 2005 were recruited and their children were observed at 24 months. A total of 186 mother-term-born child dyads completed the measurement. The five-item Mental Health Index (MHI-5) self-report data of maternal psychosocial factors were selected from the Taiwanese version of the short form 36 (SF-36). The Child Behavior Checklist for age 1½-5 (CBCL/1½-5) was completed by the parents when the child was 2 years old. The mean score of mental health around delivery was 68.11. The proportion of mothers with work stress seldom and always was 61.8% and 24.7%, respectively. The mean of the total CBCL score, and internalizing, externalizing behavior and sleep problems scores was 45.95, 11.89, 15.59 and 4.23, respectively. After adjusting for the potential confounders, maternal work stress around delivery was found to have a significant effect on the total CBCL and externalizing, attention and aggressive, behavioral problems of 2-year old children. Maternal mental health around delivery, however, did not show significant effects on child behavior. Work stress around delivery seems to aggravate children's externalizing behavior problems at 2 years old. It is therefore important to improve the psychosocial health and reduce the stress of pregnant women.

Parental functioning and pediatric sleep disturbance: An examination of factors associated with parenting stress in children clinically referred for evaluation of insomnia

Parenting stress is an aspect of parent functioning relevant in clinical settings. Within the context of behavioral sleep medicine, the role of parenting stress is not well understood. Prospective evaluation of patients 1.5-10 years old with insomnia. Subjects were 156 primary caregiver-child pairs who completed the Parenting Stress Index-Short Form (PSI-SF), Child Sleep Habits Questionnaire (CSHQ) and Child Behavior Checklist (CBCL). (1) determine prevalence of clinically significant parenting stress in primary caregivers of children clinically referred for insomnia; (2) identify childhood sleep problems that play a role in parenting stress; (3) identify relevant correlates of parenting stress within the context of a behavioral sleep medicine clinic; and (4) identify the most salient child sleep and behavioral variables associated with parenting stress. Forty-seven percent of primary caregivers had clinically significant parenting stress. When examining the relationship between child sleep problems and parenting stress, bedtime resistance (p=0.030) and daytime sleepiness (p=0.0003) stood alone as having the most salient associations with parenting stress. When considering a broader range of covariates (child age and child gender) and clinically relevant variables (parent history of sleep problems, parent history of psychiatric conditions, child behavior problems and child sleep problems) in a single regression equation, both child externalizing behavior problems (β=0.570, p<0.0001) and child daytime sleepiness (β=0.152, p=0.028) independently explained significant variability in parenting stress. Many primary caregivers of children clinically-referred for insomnia evaluation and treatment have significant parenting stress. Parenting stress is associated with daytime behavioral problems and sleepiness in children with insomnia. Clinicians working with pediatric insomnia patients should carefully evaluate parenting stress and child daytime behavior as these aspects of functioning may have an impact on service delivery and treatment outcomes.

Financial Stress, Parental Depressive Symptoms, Parenting Practices, and Children's Externalizing Problem Behaviors: Underlying Processes

This study examined the relationships among financial stress encountered by families, parents' social support, parental depressive symptoms, parenting practices, and children's externalizing problem behaviors to advance our understanding of the processes by which family financial stress is associated with children's problem behaviors. We also tested moderated mediation to investigate if these relationships differed depending on children's characteristics. The data were drawn from 290 predominantly rural families with young children who were identified as at risk for the development of serious conduct problems. Using structural equation modeling, we found that the relationship between family income and children's externalizing problem behaviors was mediated by parents' social support, parental depressive symptoms, and parenting practices. The results also showed that the children's levels of aggression severity, academic functioning, and developmental strengths moderated the mediating relationships between family income and parental depressive symptoms and between family income and positive parenting.

Caregiver Emotional Expressiveness, Child Emotion Regulation, and Child Behavior Problems among Head Start Families

The present study examined the relationships between caregivers' self-reported positive and negative emotional expressiveness, observer assessments of children's emotion regulation, and teachers' reports of children's internalizing and externalizing behaviors in a sample of 97 primarily African American and Hispanic Head Start families. Results indicated that higher caregiver negativity and lower child emotion regulation independently predicted more internalizing behavior problems in children. Additionally, children's externalizing behavior problems were negatively predicted by caregivers' self-reports of positive emotional expressiveness. Importantly, results also suggested that caregivers' emotional expressiveness and children's behavioral problems may be non-linearly related, and that child gender may play an important moderating role. These results emphasize the importance of family emotional climate and child emotion regulation in the behavioral development of preschool-age children, and highlight the need for improved theoretical and practical understanding of socioemotional development in diverse populations.

Infant-mother attachment and the growth of externalizing problems across the primary-school years

Some contend that attachment insecurity increases risk for the development of externalizing behavior problems in children. Latent-growth curve analyses were applied to data on 1,364 children from the NICHD Study of Early Child Care to evaluate the association between early attachment and teacher-rated externalizing problems across the primary-school years. Findings indicate that (a) both avoidant and disorganized attachment predict higher levels of externalizing problems but (b) that effects of disorganized attachment are moderated by family cumulative contextual risk, child gender and child age, with disorganized boys from risky social contexts manifesting increases in behavior problems over time. These findings highlight the potentially conditional role of early attachment in children's externalizing behavior problems and the need for further research evaluating causation and mediating mechanisms.

Testing a developmental cascade model of emotional and social competence and early peer acceptance.

A developmental cascade model of early emotional and social competence predicting later peer acceptance was examined in a community sample of 440 children across the ages of 2 to 7. Children's externalizing behavior, emotion regulation, social skills within the classroom and peer acceptance were examined utilizing a multitrait-multimethod approach. A series of longitudinal cross-lag models that controlled for shared rater variance were fit using structural equation modeling. Results indicated there was considerable stability in children's externalizing behavior problems and classroom social skills over time. Contrary to expectations, there were no reciprocal influences between externalizing behavior problems and emotion regulation, although higher levels of emotion regulation were associated with decreases in subsequent levels of externalizing behaviors. Finally, children's early social skills also predicted later peer acceptance. Results underscore the complex associations among emotional and social functioning across early childhood.

First-Year Maternal Employment and Child Development in the First Seven Years.

First-Year Maternal Employment and Child Development in the First Seven Years.

Paternal Psychosocial Characteristics and Corporal Punishment of Their 3-Year-Old Children

This study uses data from 2,309 biological fathers who participated in the Fragile Families and Child Well-Being Study (FFCWS) to examine associations between psychosocial characteristics and levels of corporal punishment (CP) toward their 3-year-old children over the past month. Results indicate that 61% of the fathers reported no CP over the past month, 23% reported using CP once or twice, and 16% reported using CP a few times in the past month or more. In multivariate models controlling for important sociodemographic factors as well as characteristics of the child, fathers' parenting stress, major depression, heavy alcohol use, and drug use were significantly associated with greater use of CP, whereas involvement with the child and generalized anxiety disorder were not. Girls were less likely to be the recipient of CP than were boys, and child externalizing behavior problems but not internalizing behavior problems were associated with more CP.