Child Internalizing Behavior Problems Research Articles

Caregiver Distress and Child Behavior Problems in Children with Developmental Delay from Predominantly Minoritized Backgrounds

ABSTRACT Importance Child behavior problems have been shown to contribute to caregiver distress and vice versa among youth with developmental delay (DD). However, studies have not examined these associations among children and caregivers from underrepresented ethnic/racial backgrounds. Furthermore, research has not explored how associations function differently following internet-delivered treatment or based on the level of acculturation and enculturation. Objective We examined bidirectional associations between caregiver distress (i.e. symptoms of depression, anxiety, and stress) and externalizing and internalizing behavior problems in 3- to 5-year-old children with DD from underrepresented ethnic/racial backgrounds. We also examined the impact of internet-delivered Parent–Child Interaction Therapy (iPCIT) and the moderating role of acculturation and enculturation on these bidirectional associations. Method Children aging out of early intervention services (n = 150) and their primary caregiver were randomized to receive iPCIT or referrals as usual (RAU) in the community. Results Findings provide support for bidirectional associations between child internalizing behavior problems and caregiver depressive symptoms, although there were fewer significant associations among families randomized to iPCIT compared to RAU. Weaker associations were observed among families with higher levels of enculturation, whereas stronger associations were observed among families with higher levels of acculturation. Conclusions Results highlight a sensitive period from age 3.5 to 4 years old for bidirectional associations between caregiver distress and child behavior problems and highlight the importance of addressing family cultural values during treatment. Findings also suggest the utility of internet-delivered behavioral parenting interventions in weakening the effect of child behavior problems on caregiver distress and vice versa.

부모의 정신건강 프로파일 유형 분류 및 아동의 내재화⋅외현화 문제행동 차이 비교

Objectives The purpose of this study was to classify different profiles based on the indicators of mental health at parental level and find out differences in children's internalizing/externalizing behavior problems by subtypes of parental mental health profile.
 Methods Survey data of 1,071 children and parents from the 12th Panel Study on Korean Children(PSKC) in 2019 were used for the analyses. Dyadic latent profile analysis was used for classifying subtypes of parental mental health profiles, and Three-step approach was used for testing differences in children's internalizing/externalizing behavior problems by subtypes of parental mental health profiles.
 Results First, Four subtypes(‘pattern mismatch-vulnerable mother’, ‘pattern match-vulnerable parents’, ‘pattern mismatch-vulnerable father’, ‘pattern match-stable parents’) were classified according to the indicators of parental mental health. Second, There were significant differences in children's internalizing behavior problems, ‘pattern mismatch-vulnerable mother’ and ‘pattern match-vulnerable parents’ were higher than others. Third, There were significant differences in children's externalizing behavior problem, ‘pattern match-vulnerable parents’ was the highest in externalizing behavior.
 Conclusions This study showed implications in identifying the relationships between parental mental health and children's behavior problem by exploring subtypes of parental mental health profiles in a multifaceted manner and suggested implications for improving parental mental health to attenuate children's behavior problems.

Maternal-fetal attachment, parenting stress during infancy, and child outcomes at age 3years.

Maternal-fetal attachment (MFA), a woman's relationship with and affiliative behaviors toward her unborn child, has been linked to near-term infant physical and developmental outcomes. However, further longitudinal research is needed to understand whether the impact of MFA extends past the earliest years of life. The current study explored relationships between MFA and child socioemotional competence and behavior problems at age 3 and whether parenting stress mediated the association between MFA and child outcomes. Data were collected from 221 primarily Black/African-American mothers who completed a scale of MFA during pregnancy. Mothers reported on parenting stress at infant age 7 months and reported on child socioemotional competence and problem behaviors at child age 3 years. In path analyses, MFA was directly associated with child socioemotional competence at age 3 years, but an indirect association between MFA and socioemotional competence via parenting stress was not significant. We also observed a significant indirect association between lower MFA and child internalizing behavior problems via parenting stress that was related to maternal dissatisfaction regarding interactions with her child. Findings suggest that assessing MFA may serve as a means to identify dyads who would benefit from support to promote individual health outcomes.

Maternal depressive symptoms and child behavior problems: Attachment security as a protective factor.

Maternal depressive symptoms (MDS) have been linked to both child internalizing and externalizing behavior problems. Theory suggests that child attachment security may be a protective factor against the negative effects of MDS. This study examined child attachment security as a buffer of the link between MDS and child internalizing and externalizing behavior problems at two time points in a predominantly African American sample. Participants included mothers (N = 164; Mage = 29.68 years; 76% African American) and their preschool-aged children (60% girls; Mage = 44.67 months) recruited from four Head Start centers in low-income neighborhoods in Baltimore, Maryland. MDS were concurrently associated with child internalizing and externalizing behavior problems at both time points. No significant main effects of child attachment security on behavior problems emerged; however, child attachment moderated the association between MDS and child internalizing behavior problems at Time 2, such that MDS predicted greater child internalizing problems when attachment security was low, and the effect was attenuated when attachment security was high. No interaction emerged for child externalizing problems. Findings suggest that secure attachment in early childhood can serve as a protective factor in the context of parental risk. We discuss implications for intervention and the intergenerational transmission of psychopathology.

Trajectories and Risk Factors for Pediatric Postconcussive Symptom Recovery.

Persistent postconcussive symptoms (PCS) are poorly understood in children. Research has been limited by an assumption that children with concussion are a homogenous group. To identify (i) distinctive postconcussive recovery trajectories in children and (ii) injury-related and psychosocial factors associated with these trajectories. This study is part of a larger prospective, longitudinal study. Parents of 169 children (5-18 yr) reported their child's PCS over 3 mo following concussion. PCS above baseline levels formed the primary outcome. Injury-related, demographic, and preinjury information, and child and parent mental health were assessed for association with trajectory groups. Data were analyzed using group-based trajectory modeling, multinomial logistic regression, and chi-squared tests. We identified 5 postconcussive recovery trajectories from acute to 3 mo postinjury. (1) Low Acute Recovered (26.6%): consistently low PCS; (2) Slow to Recover (13.6%): elevated symptoms gradually reducing; (3) High Acute Recovered (29.6%): initially elevated symptoms reducing quickly to baseline; (4) Moderate Persistent (18.3%): consistent, moderate levels of PCS; (5) Severe Persistent (11.8%): persisting high PCS. Higher levels of child internalizing behaviors and greater parental distress were associated with membership to the Severe Persistent group, relative to the Low Acute Recovered group. This study indicates variability in postconcussive recovery according to 5 differential trajectories, with groups distinguished by the number of reported symptoms, levels of child internalizing behavior problems, and parental psychological distress. Identification of differential recovery trajectories may allow for targeted early intervention for children at risk of poorer outcomes.

Impact of Parent-Child Relationship and Gender on Trajectories of Children Internalizing Problems

Background: Parenting and parental-child relationship may lead children to develop behavior problems that can affect many aspects of their later life, such as happiness, health, intelligence and mental illness. This study aimed to examine the impact of parent-child relationship and gender on the development of internalizing behavior problems (IBP) in children. Methods: Childhood and Adolescent Behaviors in Long-term Evolution (CABLE) is a longitudinal healthy-lifestyle research for which 18 elementary schools were randomly selected respectively in Taipei and Hsinchu in Taiwan. Data were collected on family interactions, lifestyle, problem behaviors and physical health. Data on gender, parent-child relations, and internalizing problem behaviors from four waves of follow-up were analyzed in this paper: 2003 (9 year olds), 2006 (12 year olds), 2009 (15 year olds) and 2012 (18 year olds). A latent growth model (LGM) was used to examine the impact of parental-child relationship and gender on the trajectory of children's IBP. Results: Results show that IBP is more severe (r = 0.21, p < 0.01) and their growth rate faster (r = 0.15, p < 0.01) in girls than in boys. Results from latent growth model show that parent-child relationship is negatively related to the IBP intercept (r = -0.59, p < 0.01) and is positively related to the IBP slope (r = 0.18, p < 0.01). Conclusions: The findings suggest that girls are more susceptible to IBP in puberty, and better parent-child relationship can have a protective influence although the protective impact reduced through time. Health professionals should be sensitive to gender, family functioning and provide positive parenting programs for children at risk for IBP. Funding Statement: National Health Research Institutes and Health Promotion Administration, Ministry of Health and Welfare Taiwan, grant number HP-090-SG-03. Declaration of Interests: The authors have no conflicts of interest relevant to this article to disclose. Ethics Approval Statement: This study protocol was reviewed and approved by the human protection committee of the National Health Research Institutes Taiwan.

Transactional Relations Between Parenting Stress and Child Autism Symptoms and Behavior Problems.

Parents of children with autism spectrum disorder report elevated parenting stress. The current study examined bidirectional effects between parenting stress and three domains of child functioning (ASD symptoms, internalizing behavior problems, and externalizing behavior problems) across four time points in 188 families of children with ASD (ages 5-12 years). Mother and father reports of parenting stress and child functioning were used in cross-lag models to examine bidirectional associations between parenting stress and child functioning. Results indicated parent-driven effects for child internalizing behavior problems, while child externalizing behavior problems and ASD symptoms evidenced both parent-driven and child-driven effects, in different ways for mothers versus fathers. Overall, findings have important implications for interventions for families of children with ASD.

The association of fathers' parental warmth and parenting stress to child behavior problems

This study examines whether fathers' parental warmth and parenting stress were associated with behavior problems when children were approximately 36-months of age, beyond the influence of maternal behaviors. Study participants were 3342 low-income fathers and mothers who participated in the Building Strong Families (BSF) study. Cross-sectional regression analyses indicated that for unmarried nonresidential families, fathers' parental warmth and parenting stress were associated with child internalizing behavior problems; and fathers' parenting stress only was marginally associated with child externalizing behavior problems. For consistently cohabiting residential fathers, only fathers' parenting stress was marginally associated with child internalizing behavior problems. No associations of fathers' parental warmth and parenting stress on either internalizing or externalizing behavior problems were observed in married families. Overall, study results suggest that fathers' parental warmth and parenting stress may have a modest positive association on the development of child internalizing behavior problems particularly in vulnerable families (i.e., families in which fathers were nonresidential).

Relations between parenting practices, socioeconomic status, and child behavior in Brazil

The present cross-sectional study aims to examine the relations between socioeconomic status (SES), parenting practices, and child internalizing and externalizing behavior problems in Brazil. To achieve this aim, we begin by examining the factor structure of a parenting scale (the ACT scale) for use in the Brazilian context. Participants were 204 Brazilian mothers of 3- to 8-year-old children, who answered questionnaires about SES, parenting practices, and child behavior. The results of exploratory and confirmatory factor analysis of the ACT scale revealed three latent parenting practices in the Brazilian context: emotional and behavioral regulation, communication, and positive discipline. Results of the final structural equation model showed that lower socioeconomic status was directly related to higher levels of child internalizing behavior problems and more negative parenting practices in the communication and positive discipline domains. Although mothers' emotional and behavioral regulation was not related to socioeconomic status, it was negatively predictive of children's behavior problems. The findings provide evidence for the utility of the ACT scale for measuring three distinct dimensions of parenting practices in Brazil. Results also suggest nuanced relations between SES, parenting practices, and child behavior in this developing country context.

You Will Attain My Goal

Abstract. This paper deals with parental goals for children, that is, goals parents want their children to attain by the time they reach adulthood. Presenting an adaption of the German Aspirations Index to assess parental goals for children (AI-PG), factorial structure and psychometric properties in a nonclinical sample of German parents of children between 10 and 15 years of age were investigated. Parents (NT1 = 948; NT2 = 670) rated the importance of different parental goals for children. The AI-PG structure was first examined in a subsample of mothers using confirmatory factor analyses. Main results provided support for the hypothesized hierarchical factorial structure. Accordingly, the given 21 items can be assigned to seven first-order factors that reflect goal-contents, and two second-order factors that reflect goals’ motivational orientation as either intrinsic or extrinsic. The questionnaire shows good psychometric properties (i.e., homogeneity, model-based reliability, and stability). Multiple-group analyses confirmed measurement invariance across informants (mothers and fathers), gender of target children (daughters and sons), and measurement time points. Small but significant relationships of the scales with need-threatened environment, parenting practices, and child internalizing behavior problems added to the scale’s construct validity. Results are discussed in terms of the fruitfulness of a concept of parental goals for children within self-determination theory.

Effects of Maternal Depression Symptoms and Alcohol Use Problems on Child Internalizing and Externalizing Behavior Problems

Empirical evidence suggests maternal behavioral health problems are significant predictors of child behavioral health difficulties, but it is unclear of the specific relation of maternal alcohol use problems and depression symptoms with child internalizing and externalizing behavior problems. The purpose of the study is to examine the impact of maternal depression symptoms and alcohol use problems on children’s internalizing and externalizing behavior problems over a period of 5 years. Implications for intervention may differ depending on which type of maternal behavioral health concerns predicts which child behavior problem. A total of 1874 families eligible for Early Head Start participated. Maternal depression symptoms and alcohol use problems were assessed when children were in preschool, and internalizing and externalizing behavior problems were assessed when children were in fifth grade. Clinical internalizing behavior problems was best predicted by maternal depression symptoms, whereas clinical externalizing behavior problems was best predicted by maternal alcohol use problems. Children were almost twice as likely to have clinical internalizing behavior problems when mothers exhibited very elevated depression symptoms compared to when mothers displayed minimal symptoms. A similar relation was found with maternal alcohol use problems and clinical externalizing behavior problems. Our findings highlight the importance of understanding and treating various kinds of behavioral health concerns in mothers of young children.

Emotion socialization and internalizing behavior problems in diverse youth: A bidirectional relationship across childhood

Mothers’ and fathers’ emotion socialization (ES) practices have been widely associated with child socioemotional outcomes. To extend this research, we examined the bidirectional relationship between parent ES practices (supportive and non-supportive parenting) and internalizing behavior problems in children of Anglo and Latino parents. Participants were 182 mothers and 162 fathers and their children with or without intellectual disability (ID). We compared the stability of mother and father ES practices across child ages 4–8. We utilized cross-lagged panel modeling to examine the bidirectional relationship between parents’ ES and child internalizing behavior problems. Emotion socialization practices differed across time by parent gender, with mothers displaying higher levels of supportive parenting and lower levels of non-supportive parenting than fathers. Cross-lagged panel models revealed differential relationships between child internalizing behaviors and emotion socialization practices by parent gender and by ethnicity. Implications for intervening with culturally diverse families of children with ID are discussed.

Prenatal cocaine exposure: The role of cumulative environmental risk and maternal harshness in the development of child internalizing behavior problems in kindergarten

This study examined the associations between prenatal exposure to cocaine and other substances and child internalizing behavior problems at kindergarten. We investigated whether maternal harshness or cumulative environmental risk mediated or moderated this association. Participants consisted of 216 (116 cocaine exposed, 100 non-cocaine exposed) mother–infant dyads participating in an ongoing longitudinal study of prenatal cocaine exposure. Results indicated that, as hypothesized, maternal harshness moderated the association between prenatal cocaine exposure to child internalizing in kindergarten such that prenatal cocaine exposure increased risk for internalizing problems at high levels of maternal harshness from 7 to 36months and decreased risk at low levels of harshness. Contrary to hypothesis, the association between prenatal cocaine exposure and child internalizing in kindergarten was not mediated by maternal harshness or cumulative environmental risk. However, cumulative environmental risk (from 1month of child age to kindergarten) was predictive of child internalizing behavior problems at kindergarten. Results have implications for parenting interventions that may be targeted toward reducing maternal harshness in high risk samples characterized by maternal substance use in pregnancy.

Child behavior and mother-child emotional availability in response to parent training program: moderators of outcome

The aim of this study was to assess changes in child behavior and mother-child emotional availability after mother's participation in a parent training program, and to assess the role of various factors which might explain individual variability in these changes. After mothers had participated in the parent training program they reported less child externalizing behavior problems and less child internalizing behavior problems. The child's preschool teacher also reported decreased child externalizing problems during the post-training assessment measure. Observational measures showed increased mother-child emotional availability. Post-training behavioral differences were found depending upon the child's age, with greater changes in positive mother-child emotional availability and preschool teachers reports of decreased internalizing behavior for the older group of children, 4 -5 years old. A decrease in child internalizing behavior was more prominent in families with more than one child.

A Conceptual Model Predicting Internalizing Problems in Middle Childhood Among Children of Alcoholic and Nonalcoholic Fathers: The Role of Marital Aggression

The purpose of this study was to test a conceptual model predicting children's anxiety/depression in middle childhood in a community sample of children with parents who had alcohol problems (n = 112) and those without alcohol problems (n = 101). The conceptual model examined the role of parents' alcohol diagnoses, depression, and antisocial behavior among parents of children ages 12 months to kindergarten age in predicting marital aggression and parental aggravation. Higher levels of marital aggression and parental aggravation were hypothesized to predict children's depression/anxiety within time (18 months to kindergarten age and, prospectively, to age during fourth grade). The sample was recruited from New York State birth records when the children were 12 months old. Assessments were conducted at 12, 18, 24, and 36 months; at kindergarten age; and during fourth grade. Children with alcoholic fathers had higher depression/anxiety scores according to parental reports but not self-reports. Structural equations modeling was largely supportive of the conceptual model. Fathers' alcoholism was associated with higher child anxiety via greater levels of marital aggression among families with alcohol problems. Results also indicated that there was a significant indirect association between parents' depression symptoms and child anxiety via marital aggression. The results highlight the nested nature of risk characteristics in alcoholic families and the important role of marital aggression in predicting children's anxiety/depression. Interventions targeting both parents' alcohol problems and associated marital aggression are likely to provide the dual benefits of improving family interactions and lowering risk of children's internalizing behavior problems.

Family Stability as a Protective Factor Against Psychopathology for Urban Children Receiving Psychological Services

Family stability, defined as the consistency of family activities and routines, was examined in a sample of urban families (n = 70) with children (ages 7 to 16) receiving psychological services. Parent-reported family stability was associated with lower parent-reported children's internalizing behavior problems. Child-reported family stability significantly attenuated the influence of parental depressive symptoms on parent-reported children's internalizing, externalizing, and total behavior problems, while controlling for the effect of children's age. Parental depressive symptoms were associated with problems in child adjustment only at the low level of family stability.

Emotion Socialization in Maltreating and Nonmaltreating Mother-Child Dyads: Implications for Children's Adjustment

This study investigated maternal emotion socialization in physically maltreating and nonmaltreating mother-child dyads (N = 63 dyads) to examine the relation between maternal support in response to children's emotional displays and children's psychological adjustment (i.e., internalizing and externalizing behavior problems). Child participants consisted of both boys (64%) and girls (36%) and ranged from 6 to 12 years of age. Findings indicated maltreatment negatively predicted maternal support and positively predicted children's internalizing and externalizing problems. Further, maternal support negatively predicted children's internalizing and externalizing problems. Finally, maternal support partially mediated the relation between maltreatment and internalizing problems. No mediation was indicated for externalizing difficulties. Findings suggest that a lack of maternal support in response to children's emotion is particularly important to the development of children's internalizing behavior problems.

Psychosocial Predictors of Distress in Parents of Children Undergoing Stem Cell or Bone Marrow Transplantation

To examine psychosocial predictors of distress (mood disturbance, perceived stress, caregiver burden) in parents of children undergoing stem cell or bone marrow transplantation (BMT). Measures of prior illness experiences, premorbid child behavior problems, family environment, social support, and parental coping behavior were obtained from the resident parents of 151 children prior to the children's admission for BMT. Parents subsequently completed assessments of their mood disturbance, perceived stress, and caregiving burden on a weekly basis through week +6 post-BMT, and then monthly through month +6 post-BMT. Significant changes were observed in parental distress across the course of BMT. After correcting for demographic and medical factors, several significant predictors of parental distress trajectories were identified, including prior parent and patient illness-related distress, premorbid child internalizing behavior problems, the family relationship dimensions of the family environment, and parental avoidant coping behaviors. Multivariable models were developed using a hierarchical modeling approach. The best-fit model accounted for approximately 50% of the variance in parental global distress. Subgroups of parents at higher risk for increased distress during the acute phase of transplant have been identified. These findings can help target parents who may be in greater need of intervention aimed at reducing transplant-related distress.

Marital Aggression, Mother's Problem-Solving Behavior with Children, and Children's Emotional and Behavioral Problems

This study examined: 1) the relationship between marital aggression and mother's behavior during problem-solving interactions with her child, and 2) the contribution of these two variables to the prediction of children's emotional and behavioral problems. Forty-three mother-child dyads and 35 of the children's teachers were included in this investigation. Marital aggression was assessed by mothers and children; mother's problem solving behavior with children was assessed using both questionnaire and observational measures; and child emotional and behavioral adjustment was assessed by mothers, children, and teachers. The pattern of results obtained suggests that mother's involvement in aggressive marital conflict is significantly related to angry and power assertive maternal behavior during problem-solving interactions with children. Both marital aggression and mothers' reported use of power assertion during problem-solving interactions with children contributed uniquely to the prediction of mother reports of child externalizing behavior problems, while only mothers' reported use of power assertion contributed significantly to the prediction of mother reported child internalizing behavior problems. Only marital aggression, however, contributed significantly to the prediction of child and teacher reports of child problems.

The role of family processes and coping strategies in the relationship between parental chronic illness and childhood internalizing problems.

Sixty-nine families (father, mother, and one child) in which the father had hemophilia, approximately half of whom were HIV positive, were assessed in an examination of the relationship between parental chronic illness, family functioning, child coping strategies, and child adjustment. Latent variable path analyses with partial least-squares estimation procedures (PLS) were used to test a model of the relationship between parental chronic illness, family process variables, child coping strategies, and child internalizing behavior problems. The severity of the father's illness predicted family process variables, which predicted the coping style of the child. The use of more avoidant coping strategies was associated with more internalizing problems.