Early Childhood Behavior Problems Research Articles

Early Detection of Temperament Risk Factors: A Comparison of Clinically Referred and General Population Children.

Despite an extensive literature on associations between early childhood temperament and behavior problems, most of this evidence is based on general population samples. Hence, relatively little is known about the temperament characteristics of children who have been referred for in- or outpatient treatment of emotional and/or behavioral problems. Whether temperament-to-behavior problems identified in community samples would also be found in samples of clinically referred children is poorly understood. To redress this limitation, we compared temperament attributes of a predominantly preschool-aged sample of children referred for treatment of emotional and/or behavioral disorders (N = 87) with those from a similarly-aged general population sample (N = 85) by using the Integrative Child Temperament Screener (ICTS)—a new nine-item scale to identify clinically significant temperament attributes. Behavioral symptoms in the clinical sample were assessed through diagnostic interviews in combination with the Child Behavior Checklist (CBCL), which was also administered to the general population children. Compared with general population children, referred children exhibited substantially higher scores on all ICTS subscales except behavioral inhibition. Furthermore, areas under the curve analyses showed that discrimination of both groups based on CBCL scales could be improved by adding the ICTS. Overall, the findings fill a long-standing gap in evidence regarding temperament characteristics of children with serious emotional and/or behavioral symptoms and suggest a useful role for the ICTS in assessment, screening, and prevention.

Postpartum Depression, Complications During Pregnancy, and Offspring Behavior Problems in Early Childhood

Postpartum Depression, Complications During Pregnancy, and Offspring Behavior Problems in Early Childhood

Household Chaos and Early Childhood Behavior Problems: The Moderating Role of Mother-Child Reciprocity in Lower-Income Families.

The study examined whether mother-child reciprocity across increasingly challenging contexts moderated the association between household chaos and early childhood behavior problems. Living in a chaotic household is associated with behavioral dysregulation in childhood. An important goal in discordant household contexts is to establish positive aspects of relationships that are associated with more favorable developmental outcomes. The study analyzed data from 127 mother-child dyads participating in the 3-year visit in a study of primarily low-income, African American/Black families in urban areas. Dyads were videotaped during three successive, increasingly challenging, interaction tasks. Multiple regression analyses examined household chaos, dyadic reciprocity, and the interplay of those as predictors of behavior problems. Greater household chaos was associated with more internalizing and externalizing behavior problems. Moderation analyses indicated that dyadic reciprocity during two challenging interaction tasks (but not during free play) attenuated the association between household chaos and internalizing problems. Household chaos was not associated with internalizing problems among dyads who had a connected, supportive relationship in more challenging interactive contexts. Improving shared positive affect and dyadic harmony in the parent-child relationship may help protect young children against the negative influence of chaotic contexts.

Adverse Childhood Experiences and Spanking Have Similar Associations with Early Behavior Problems

To examine whether adverse childhood experiences (ACEs) and physical punishment (ie, spanking) are unique risk factors for behavior problems in early childhood, and whether ACEs moderate the associations of spanking with child behavior problems. We conducted prospective, longitudinal analyses on 2380 families in the Fragile Families and Child Wellbeing Study. Mothers reported outcomes of externalizing and internalizing behavior problems at age 5 years; and the main predictors, ACEs and spanking, at age 3 years. ACEs included 9 items: physical abuse, emotional abuse, physical neglect, emotional neglect, mother's exposure to intimate partner violence, parental mental health problem, parental substance use, parental incarceration, and parental death. Multilevel models examined the associations between ACEs, spanking, and behavior problems, and the moderating effect of ACEs in the associations of spanking with behavior problems. Analyses were adjusted for preexisting behavior problems, demographics, and neighborhood conditions. ACEs (β=0.028; P<.001) and spanking (β=0.041; P<.001) at 3years were unique risk factors for increased externalizing behavior problems at 5years, after controlling for covariates. The magnitude of the associations of ACEs and spanking with externalizing behavior were statistically indistinguishable. ACEs did not moderate the association between spanking and externalizing behavior. ACEs and spanking have similar associations in predicting child externalizing behavior. Results support calls to consider physical punishment as a form of ACE. Our findings also underscore the importance of assessing exposure to ACEs and physical punishment among young children and providing appropriate intervention to children at risk.

Effect of Therapist Coaching Statements on Parenting Skills in a Brief Parenting Intervention for Infants.

Behavioral parenting interventions have been shown to decrease early childhood behavior problems by improving parenting skills. Few studies have examined the impact of therapist coaching statements on parenting skill acquisition, especially among ethnic minority families and non-English-speaking families. In this study, we examined therapists' use of responsive and directive coaching statements during the first coaching session in a brief parenting intervention, the Infant Behavior Program (IBP), on changes in parenting skill acquisition. Participants were 24 mothers of 12- to 15-month-olds, with elevated levels of behavioral problems from primarily Latinx and low-income backgrounds. Mothers who heard more responsive coaching from their therapist showed greater increases in positive parenting skills. Spanish-speaking therapists used fewer responsive coaching statements and more commands, however, language spoken did not moderate the effect of these statements on changes in parenting skills. Responsive coaching statements in English and Spanish had a positive impact on parenting skill acquisition.

Parental Relationship Status as a Moderator of the Associations Between Mothers’ and Fathers’ Conflict Behaviors and Early Child Behavior Problems

This study examines interparental conflict and associations with child behavior problems among a large, diverse sample of families with low income (N = 2,691) using path model analyses of mothers' and fathers' reports of constructive interparental conflict, destructive interparental conflict, and intimate partner violence (IPV) victimization at 15 months and child emotional insecurity and child behavior problems at 36 months. Multigroup models examined whether parental relationship status (i.e., married, cohabiting, and churning) moderated these associations. Fathers' perceptions of interparental conflict behaviors showed few direct associations with child outcomes, whereas mothers' perceptions of interparental conflict showed more robust associations with child outcomes. Specifically, mother-reported destructive conflict was associated with higher levels of child emotional insecurity and child behavior problems across parental relationship status subgroups. Mother-reported constructive conflict had a small negative association with child behavior problems in cohabiting families. Child emotional insecurity mediated the association of maternal destructive conflict on child behavior problems. Although churning families experienced higher levels of moderate and severe interparental conflict, associations linking destructive conflict to child behavior problems were consistent across parental relationship subgroups. There were few direct effects of father-reported constructive and destructive conflict on child well-being. However, the results supported the notion that fathers play an influential role in the family system via maternal reports of IPV victimization. Results of this study suggest that the mechanisms underlying emotional security theory, in which child emotional insecurity mediates the associations between maternal destructive conflict and child behavior problems, apply to a large and racially diverse sample of socioeconomically disadvantaged children.

Does community violence exposure moderate the associations between maternal spanking and early child behavior problems?

A robust research literature links parental spanking with negative behavioral outcomes for children, however, it remains unclear whether conditions in the community may moderate the associations between spanking and behavior problems in early childhood. In the current study, we examined whether community violence exposure moderated the associations of maternal spanking with externalizing and internalizing behavior problems of young children. The sample used in this study was urban families and their children ages 3-5 (n = 2,472). We used fixed effects regression models, which yield stronger statistical control for baseline behavior problems, selection bias, and omitted variables bias. Mother's spanking was associated with elevated levels of both externalizing (β = .037, p < .001) and internalizing (β = .016, p < .001) behavior problems. Community violence exposure also predicted higher levels of externalizing (β = .071, p < .01) and internalizing (β = .043, p < .05) behavior problems. Community violence exposure did not moderate the associations between maternal spanking and behavior problems. Professionals working with families should promote the use of nonphysical disciplinary practices, regardless of the level of violence and crime in the community in which the family resides.

Infant-directed language following a brief behavioral parenting intervention: The importance of language quality

Behavioral parenting interventions decrease early childhood behavior problems and increase positive parenting skills. However, few studies have examined the impact of low intensity interventions for infants at risk for behavior problems on changes in parent language. This study examined the effect of a brief parenting intervention, the Infant Behavior Program, on changes in parent linguistic input and its influence on infant language. Participants were 58 mothers and their12- to 15-month-olds, with elevated levels of behavioral problems. Mothers and their infants were from primarily Hispanic and low-income backgrounds. Mother-infant dyads were randomly assigned to receive the Infant Behavior Program or standard pediatric primary care. Mothers receiving the Infant Behavior Program provided more linguistic input, which indirectly influenced infant language, and suggest targeting infants at risk for behavior problems can have a broader impact on language development.

The Association Between Persistence and Change in Early Childhood Behavioural Problems and Preschool Cognitive Outcomes.

The link between behavioural and cognitive difficulties is well established. However, research is limited on whether persistence and change in behavioural difficulties relates to cognitive outcomes, particularly during preschool. We used a large New Zealand birth cohort to investigate how persistence and change in serious behavioural problems from ages 2 to 4.5years related to measures of cognitive delay at 4.5years (n = 5885). Using the Strengths and Difficulties total problems score at each time point, children were categorised as showing no difficulties, improved behaviour, concurrent difficulties, and persistent difficulties. Cognitive measures assessed included receptive language, early literacy ability, and executive control. Our results showed that children with concurrent and persistent behavioural difficulties were at a greater risk of showing delays within specific cognitive domains relative to children with no difficulties and were also more likely to show comorbid delays across multiple cognitive domains.

Family social support buffers the intergenerational association of maternal adverse childhood experiences and preschoolers’ externalizing behavior.

Despite previous work demonstrating that an accumulation of maternal adverse childhood experiences (ACEs) is associated with negative health outcomes across generations, few studies have investigated protective factors beyond the parent-child dyad in the intergenerational transmission of adversity. The current study extends previous findings by examining maternal family social support as a culturally relevant buffer in the association between mothers' ACEs and her children's behavior problems in early childhood. Participants included 121 African American mothers and their preschool-aged children experiencing high sociodemographic risk. Mothers completed questionnaires on ACEs, perceived family social support, children's violence exposure and behavior problems as well as relevant demographics. Maternal family social support moderated the relation between maternal ACEs and children's externalizing behaviors (b = -.14, p < .01), such that children of mothers who reported high ACEs and also moderate to high family social support did not show elevated externalizing behaviors; this pattern was not observed for internalizing behaviors (b = -.06, p = .06). Additionally, the intergenerational buffering effects of family social support were observed above and beyond mothers' psychopathology and children's exposure to violence. These results have implications for culturally relevant prevention and intervention efforts supporting African American mothers with young children that reflect resiliency in the face of disparities across generations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Medicaid Instability and Mental Health of Teen Parent Families.

This study examines the effect of inconsistent Medicaid coverage on parenting stress, maternal depression, and child behavior in a sample of teen mothers and their children. The majority (54%) of mothers experienced inconsistent coverage. After 24 months, mothers experiencing inconsistent coverage had significantly higher parenting stress and depressive symptoms, and their children had more internalizing behaviors than families with consistent Medicaid. These differences existed despite no initial differences and controlling for numerous covariates. Policies and practices that stabilize Medicaid coverage for teen parent families may reduce unnecessary stress, depressive symptoms, and early childhood behavior problems.

Maternal Anxiety, Parenting Stress, and Preschoolers' Behavior Problems: The Role of Child Self-Regulation.

Maternal anxiety is a well-known risk factor for early childhood behavior problems. In this study, we explore (1) whether parenting stress mediates this relation and also (2) whether child factors, namely self-regulation, modify the influence of maternal well-being on child externalizing and internalizing problems at 4 years of age. Mothers taking part in the Growing Up in Singapore Towards Healthy Outcomes cohort completed the Spielberger State-Trait Anxiety Inventory when their children were 24 months of age. At 42 months of age, children performed a self-regulation task (n = 391), and mothers completed the Parenting Stress Index. When children were 48 months old, both parents completed the Child Behavior Checklist. As predicted, parenting stress mediated the relation between maternal trait anxiety and child externalizing and internalizing problems. This mediating effect was further moderated by child self-regulation. The indirect effect of maternal trait anxiety through parenting stress on child externalizing problems was stronger among children with low self-regulation. Parenting stress is an additional pathway connecting maternal trait anxiety and children's externalizing and internalizing behavior problems. The risk for child externalizing problems conveyed by elevated maternal trait anxiety and parenting stress may be buffered by better self-regulation in 4-year-olds. These results suggest that interventions that include decreasing parenting stress and enhancing child self-regulation may be important to limiting the transgenerational impact of maternal trait anxiety.

Organized Chaos: Daily Routines Link Household Chaos and Child Behavior Problems

The aim of this study was to examine daily routines as a potential mediator of the relation between household chaos and both child externalizing behavior and bedtime resistant behavior. Studies show that children living in chaotic households exhibit more externalizing behaviors, which when exhibited as early as the toddler and preschool years, are a risk factor for later maladjustment. Understanding the mechanisms linking household chaos to early externalizing behaviors is important since those mechanisms could be targeted as a point of intervention. Using Amazon’s Mechanical Turk (Mturk), parents (n = 120) of a child age 2–5 completed questionnaires online assessing household chaos, frequency of routines, and child behavior problems. There was a significant indirect effect of household chaos to child behavior problems through family routines (B = 0.09, SE = 0.05, CI [0.01, 0.23]) and general child routines (B = 0.15, SE = 0.06, CI [0.05, 0.31]) (independently) and an indirect effect of household chaos to bedtime resistant behavior through children’s bedtime routines (B = 0.12, SE = 0.06, CI [0.03, 0.26]). These findings suggest that household chaos and routines are distinctive constructs and that routines are a mechanism linking household chaos to early child behavior problems. Clinically, these results imply that routines may be a reasonable focus for intervention among families living in chaotic households who have young children exhibiting behavior problems.

More than Mental Health: Parent Physical Health and Early Childhood Behavior Problems.

Caring for young children is a physically demanding task, and some evidence suggests parental physical limitations may impact the parent-child relationship and child behavioral development, but research examining this dynamic is nascent. This study aims to explicate the role of general parent physical health problems in child disruptive behavior outcomes. A model that included physical and mental health, parenting style and self-efficacy, and child behavior symptom ratings was derived. The tenability of the model was assessed using Pearson's correlations, followed by structural equation modeling using data from 375 parents with a child between 18 months and 5 years. After several modifications to the initial model, findings revealed that higher levels of parent self-reported physical and mental health concerns indirectly influence child behavior symptoms through different pathways. Impaired parent physical health was associated with poorer parental self-efficacy and more disruptive child behavior, whereas increased parent mental health concerns were associated with a more negative parenting style and lower self-efficacy, which was related to more child behavior symptoms. Findings elucidate the need for increased awareness and screening of parent physical health limitations in pediatric primary care. Furthermore, appropriate interventions among parents with physical health problems may target different aspects of parenting than routinely discussed.

Determinants of Persistence and Change in Early Childhood Behavioural Problems: The Roles of Parenting and Maternal Mental Health

The current study aimed to investigate factors associated with the persistence and change in behavioural difficulties during early childhood. The study used data from the Growing Up in New Zealand birth cohort. Maternal-rated behavioural difficulties were assessed when children were aged 2 and 4.5 years (N = 5885). The ninetieth percentile of the Strengths and Difficulties total difficulties score was used to identify children who showed serious behavioural difficulties at each time point, with children then categorised as showing no difficulties, improved behaviour, later difficulties, and persistent difficulties. Predictors of interest related to maternal-reported mental health and parenting behaviour, family social support and exposure to physical and verbal inter-parental conflict. Poor maternal mental health at multiple time points and authoritarian and physical punishment parenting styles were associated with an increased likelihood of developing behavioural difficulties at 4.5 years and showing persistent difficulties from 2 to 4.5 years. Physical punishment and authoritarian parenting styles also mediated the association between a history of verbal inter-parental conflict and both developing later difficulties and persistent difficulties, whereas only physical punishment parenting style mediated this association for a history of physical inter-parental conflict. The only factor that distinguished children who improved from children who persisted was maternal parenting self-evaluation at 9 months; mothers who had a better self-evaluation were more likely to have children who persisted than improved. These results demonstrate the importance of addressing mothers’ self-reported management of their children’s behavioural difficulties, inter-parental conflict and maternal emotional wellbeing.

Association of Behavior in Boys From Low Socioeconomic Neighborhoods With Employment Earnings in Adulthood

Identifying early childhood behavioral problems associated with economic success/failure is essential for the development of targeted interventions that enhance economic prosperity through improved educational attainment and social integration. To test the association between kindergarten teacher-rated assessments of inattention, hyperactivity, opposition, aggression, and prosociality in boys with their employment earnings at age 35 to 36 years as measured by government tax return data. A 30-year prospective follow-up study analyzing low socioeconomic neighborhoods in Montreal, Quebec, Canada. Boys aged 5 to 6 years attending kindergarten in low socioeconomic neighborhoods were recruited. Teacher-rated behavioral assessments were obtained for 1040 boys. Data were collected from April 1984 to December 2015. Analysis began January 2017. Mixed-effects linear regression models were used to examine the association between teacher ratings of inattention, hyperactivity, opposition, aggression, and prosociality at age 6 years and individual earnings obtained from government tax returns at age 35 to 36 years. The IQ of the child and family adversity were adjusted for in the analysis. Complete data were available for 920 study participants (mean age at follow-up was 36.3 years). Mean (SD) personal earnings at follow-up were $28 865.53 ($24 103.45) (range, $0-$142 267.84). A 1-unit increase in inattention (mean [SD], 2.66 [2.34]; range, 0-8) at age 6 years was associated with decrease in earnings at age 35 to 36 years of $1295.13 (95% CI, -$2051.65 to -$538.62), while a unit increase in prosociality (mean [SD], 8.0 [4.96]; range, 0-20) was associated with an increase in earnings of $406.15 (95% CI, $172.54-$639.77). Hyperactivity, opposition, and aggression were not significantly associated with earnings. Child IQ was associated with higher earnings and family adversity with lower earnings in all models. A 1-SD reduction in inattention at age 6 years was associated with a theoretical increase in annual earnings of $3040.41, a similar magnitude to an equivalent increase in IQ. Teacher ratings of inattention and prosociality in kindergarten boys from low socioeconomic neighborhoods are associated with earnings in adulthood after adjustment for hyperactivity, aggression, and opposition, which were not associated with earnings. Interventions beginning in kindergarten that target boys' inattention and enhance prosociality could positively impact workforce integration and earnings.

Role of Parenting Style in Children's Behavioral Problems through the Transition from Preschool to Elementary School According to Gender in Japan.

While ineffective discipline can be attributed to authoritarian and permissive parenting styles, little research has examined the role of gender in the association between parenting style and early childhood behavioral problems. Thus, this study aimed to clarify the effects of authoritarian and permissive parenting on children’s externalizing and internalizing behaviors during the preschool-to-elementary-school transition according to gender in Japan. A sample of 1668 Japanese children (853 boys and 815 girls) were followed longitudinally over one-year intervals, and assessed based on parenting styles (the Parenting Scale), children’s behavioral problems (the Strengths and Difficulties Questionnaire), and family characteristics. Multivariate analyses revealed that, when analyzed by gender, authoritarian discipline influenced externalizing problems in boys (β = 0.048, p = 0.047) and girls (β = 0.067, p = 0.023), while permissive discipline influenced externalizing problems in boys only (β = 0.049, p = 0.038). The results document the relationship between family processes and the development of disruptive behavior disorders in children. Support for parents employing such child-rearing styles in early childhood may be effective in reducing school maladjustment.

Infant temperament and behavioral problems: analysis of high-risk infants in child welfare

ABSTRACTResearchers have demonstrated the association between difficult temperament in infancy and early childhood behavioral problems, but to date this has not been demonstrated in the child welfare population. This study utilized the National Survey of Child and Adolescent Well-Being (NSCAW), a nationally representative, longitudinal survey of children in the child-welfare system. The sample consisted of 1084 infants 0–12 months old at baseline who were investigated for suspected child abuse. The researchers used longitudinal, multivariable logistic regression to examine the association between difficult temperament score in infants 0–12 months who had child welfare involvement and clinical-range Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000) score at 36-months-follow-up. Findings from this study suggest that among children with substantiated maltreatment, difficult temperament in infancy predicts early childhood behavioral problems. This relationship persists after adjusting for other risk factors, such as placement, caregiver depression, and family income. The study also discusses implications for child welfare practices.Abbreviations: National Survey of Child and Adolescent Wellbeing II (NSCAW-II); Child Behavior Checklist (CBCL); Early Childhood Behavioral Problems (ECBPs)

Using Early Childhood Behavior Problems to Predict Adult Convictions.

The current study examined whether teacher and parent ratings of externalizing behavior during kindergarten and 1st grade accurately predicted the presence of adult convictions by age 25. Data were collected as part of the Fast Track Project. Schools were identified based on poverty and crime rates in four locations: Durham, NC, Nashville, TN, Seattle, WA, and rural, central PA. Teacher and parent screening measures of externalizing behavior were collected at the end of kindergarten and 1st grade. ROC curves were used to visually depict the tradeoff between sensitivity and specificity and best model fit was determined. Five of the six combinations of screen scores across time points and raters met both the specificity and sensitivity cutoffs for a well-performing screening tool. When data were examined within each site separately, screen scores performed better in sites with high base rates and models including single teacher screens accurately predicted convictions. Similarly, screen scores performed better and could be used more parsimoniously for males, but not females (whose base rates were lower in this sample). Overall, results indicated that early elementary screens for conduct problems perform remarkably well when predicting criminal convictions 20years later. However, because of variations in base rates, screens operated differently by gender and location. The results indicated that for populations with high base rates, convictions can be accurately predicted with as little as one teacher screen taken during kindergarten or 1st grade, increasing the cost-effectiveness of preventative interventions.

Accumulation, Timing, and Duration of Early Childhood Adversity and Behavior Problems at Age 9

We utilized a life course framework to examine associations between the accumulation, timing, and duration of adverse childhood experiences (ACEs) across early childhood (ages 1–5 years) and internalizing and externalizing behavior problems at age 9. The sample included 1,789 children from the Fragile Families and Child Wellbeing Study, a birth cohort study of children born between 1998 and 2000. Primary caregivers reported on seven ACEs at child ages 1, 3, 5, and 9. We created 2 summary measures of early childhood ACEs to capture (a) accumulation and (b) timing and duration. We derived indicators of caregiver-reported internalizing and externalizing problems at ages 5 and 9. Logistic regression was used to estimate associations between early childhood ACEs and behavior problems at age 9, sequentially adjusting for sociodemographic covariates, age 9 ACEs, and age 5 behavior problems. In fully adjusted models, children exposed to 6 or more ACEs in early childhood faced 3 times the odds of age 9 behavior problems, compared to children exposed to 0–1 ACE. Intermittent adversity was associated with the greatest increase in odds of age 9 behavior problems, relative to other early childhood timing/duration categories. Categories of high early and high late adversity were also associated with age 9 behavior problems. Chronic adversity was not associated with age 9 behaviors in final models that adjusted for age 5 problems. These results demonstrate the importance of a developmental perspective for understanding the role of childhood adversity in the etiology of child psychopathology.