Externalizing Behaviors In Children Research Articles

Joint Effects of Indoor Air Pollution and Maternal Psychosocial Factors During Pregnancy on Trajectories of Early Childhood Psychopathology.

Prenatal indoor air pollution and maternal psychosocial factors have been associated with adverse psychopathology. We used environmental exposure mixture methodology to investigate joint effects of both exposure classes on child behavior trajectories. For 360 children from the South African Drakenstein Child Health Study, we created trajectories of Child Behavior Checklist scores (24, 42, 60 months) using latent class linear mixed effects models. Indoor air pollutants and psychosocial factors were measured during pregnancy (2nd trimester). After adjusting for confounding, single-exposure effects (per natural log-1 unit increase) were assessed using polytomous logistic regression models; joint effects using self-organizing maps (SOM), and principal component (PC) analysis. Three trajectories were chosen for both internalizing and externalizing problems, with "high" (externalizing) or "increasing" (internalizing) being the most adverse trajectories. High externalizing trajectory was associated with increased particulate matter (PM10) exposure (OR [95%-CI]: 1.25 [1.01,1.55]) and SOM exposure profile most associated with smoking (2.67 [1.14,6.27]). Medium internalizing trajectory was associated with increased emotional intimate partner violence (2.66 [1.17,5.57]), increasing trajectory with increased benzene (1.24 [1.02,1.51]) and toluene (1.21 [1.02,1.44]) and the PC most correlated with benzene and toluene (1.25 [1.02, 1.54]). Prenatal exposure to environmental pollutants and psychosocial factors was associated with internalizing and externalizing child behavior trajectories. Understanding joint effects of adverse exposure mixtures will facilitate targeted interventions to prevent childhood psychopathology.

Does Parental Mental Health Moderate the Association between Parenting Stress and Child Externalizing Behaviors Among Autistic Children?

Parents of autistic children experience significant parenting stress, which is prospectively associated with increases in child externalizing behaviors. However, family factors that place specific families at risk for experiencing the negative impacts of parenting stress on child externalizing behaviors have not been identified. The present study examined whether parental mental health moderates the association between parenting stress and child externalizing behaviors. Parents of 501 autistic children (Mage=5.16yrs) completed the Parenting Stress Index and Eyberg Child Behavior Inventory. Parents reported whether they had ever been diagnosed with a mental health disorder. Parenting stress, parental internalizing diagnosis, and parental externalizing diagnosis all independently predicted child externalizing behavior. However, parenting stress did not interact with any category of parental mental health diagnoses to predict child externalizing. Results implicate high levels of parenting stress as a risk factor for increased child behavior problems among autistic children across parental mental health statuses. Interventions aimed at reducing parenting stress may improve parent outcomes and prevent the development of child externalizing behaviors among families of autistic children.

Parental Burnout and Child Behavior: A Preliminary Analysis of Mediating and Moderating Effects of Positive Parenting.

Despite its significant growth over the past fifteen years, research on parental burnout is just beginning to explore the relationships of the syndrome with child behavior. Previous research with adolescents has shown the existence of associations between parental burnout and internalizing and externalizing behaviors in the offspring. The current study is an attempt to (i) replicate this preliminary evidence specifically among Chilean preschool children and (ii) explore the mediating/moderating effects of positive parenting that may be involved in these putative associations. A sample of 383 Chilean mothers participated in this cross-sectional online study. The results confirmed the associations between parental burnout and child internalizing and externalizing behaviors. We also observed that positive parenting was a mediator in the relationship linking parental burnout and the child's internalizing (full mediation) and externalizing (partial mediation) behaviors. Positive parenting also partially mediated the association between the child's externalizing behavior and parental burnout. Our results further suggested that the child's externalizing behavior was possibly a more substantial contributing factor to parental burnout than the child's internalizing behavior.

The role of mother's and child's self-regulation on bidirectional links between harsh parenting and child externalizing problems.

The authors examined task-based (i.e., executive function), surveyed (i.e., effortful control), and physiological (i.e., resting cardiac respiratory sinus arrhythmia [RSA]) measures of child and maternal regulation as distinct moderators of longitudinal bidirectional links between child externalizing (EXT) behaviors and harsh parenting (HP) from 6 to 9 years. The sample size was 299 (50.9% female; 1% Asian, 4% multiple races; 14% Black; 78% White), and participants were recruited in the United States (a rural college town in Virginia and a midsized city in North Carolina). Higher child EXT at 6 years predicted higher HP at 7-8 years, which predicted higher EXT at 9 years. Also, this path was moderated by 6-year child effortful control, 6-year resting RSA, and 9-year executive function. In contrast, there was no moderating effect of any measure of maternal regulation. Findings suggest it is important to consider child self-regulation when examining bidirectionality in parent and child effects for HP and child EXT. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predicting child externalizing behavior ratings in Head Start: Investigating the impact of child and teacher influences

One of the primary goals of early education is to promote overall school readiness, especially for children most at risk for educational challenges. However, there is a persistent disparity in equitable access to high quality early learning environments. This is due in part to children being suspended or expelled for displaying challenging behaviors even though for many children, some of these behaviors may be developmentally appropriate. The effects of exclusionary discipline can have long-term implications for their overall emotional and social development. Racial and gender-based disparities in school discipline begin as early as preschool. Some of these disparities can stem from disproportionality in teachers’ perceptions of children's behaviors. The ways in which teachers perceive and subsequently respond to preschoolers’ behavior have significant implications for children's experience in the classroom and are an important link in understanding decision-making pathways related to preschool expulsion. The goal of the present study was to examine factors that might predict teacher perceptions (i.e., ratings) of child externalizing (hyperactive and aggressive) behaviors. This study analyzed secondary data from a nationally representative study of Head Start. Findings indicated there were differences in how teachers rated children's externalizing behaviors based on child's sex and race. Further, a teacher's field of study, beliefs about family engagement, and attitudes toward Developmentally Appropriate Practices significantly predicted their ratings of children's aggressive and hyperactive behaviors. Policy recommendations are discussed.

Maternal pre-pregnancy weight status and gestational weight gain in association with child behavior: The mediating role of prenatal systemic inflammation

Maternal pre-pregnancy obesity and excessive gestational weight gain (EGWG) may predispose children to behavioral problems through increased prenatal inflammation. We investigated the association between maternal body mass index (BMI) and gestational weight gain (GWG), and child behavioral problems (primary aim), and the mediating role of prenatal inflammation (secondary aim). We used self-reported pre-pregnancy BMI and estimated-GWG data (N=1137) from a longitudinal cohort study. Maternal serum C-reactive protein (CRP) was measured in the 3rd-trimester. Parent-reported Child Behavior Checklist (CBCL) was used to assess child internalizing and externalizing behaviors at 3-years-of-age. We used analysis of covariance (ANCOVA), multiple linear regression, and mediation analyses for data analysis. Maternal obesity (F=21.98, df 3836), EGWG (F=6.53, df 2764), and their combination (F=18.51, df 3764) were associated with the 3rd trimester CRP, but not child behavior in the whole sample. Maternal underweight was associated with withdrawal problems in all children (β=0.56, 95%CI, 0.11,1.00) and aggressive behaviors in female children (β=2.59, 95%CI, 0.28,4.91). Obesity had a significant association with externalizing behaviors in female children after controlling for maternal CRP (β=3.72, 95%CI, 0.12,7.32). Both inadequate and EGWG were associated with somatic complaints in male children (β=0.50, 95%CI, 0.05,0.95; β=0.36, 95%CI, 0.01,0.71, respectively). Combined obesity/EGWG was associated with externalizing (β=6.12, 95%CI, 0.53,11.70) and aggressive (β=4.23, 95%CI, 0.90,7.56) behaviors in female children. We found no significant effects through CRP. Maternal pre-pregnancy BMI and GWG showed sex-specific associations with child behavioral problems. Prenatal CRP, although increased in obesity and EGWG, did not mediate these associations.

Multiple Risk in Pregnancy- Prenatal Risk Constellations and Mother-Infant Interactions, Parenting Stress, and Child Externalizing and Internalizing Behaviors: A Prospective Longitudinal Cohort Study from Pregnancy to 18 Months Postpartum.

Multiple risk is associated with adverse developmental outcomes across domains. However, as risk factors tend to cluster, it is important to investigate formation of risk constellations, and how they relate to child and parental outcomes. By means of latent class analysis patterns of prenatal risk factors were identified, and relations to interactional quality, parenting stress, and child internalizing and externalizing behaviors were investigated. An array of prenatal risk factors was assessed in 1036 Norwegian pregnant women participating in a prospective longitudinal community-based study, Little in Norway. Mother-infant interactions were videotaped and scored with the Early Relational Health Screen (ERHS) at 12months. The Parenting Stress Index (PSI) and Infant-Toddler Social and Emotional Assessment (ITSEA) were administered at 18months. First, we analyzed response patterns to prenatal risks to identify number and characteristics of latent classes. Second, we investigated whether latent class membership could predict mother-child interactional quality, parenting stress, and child internalizing and externalizing behavior after the child was born. Results revealed three prenatal risk constellations: broad risk (7.52%), mental health risk (21.62%) and low-risk (70.86%). Membership in the broad risk group predicted lower scores on interactional quality, while membership in the mental health risk group predicted less favorable scores on all outcome measures. Prenatal risks clustered together in specific risk constellations that differentially related to parent, child and interactional outcomes.

5.30 The Double-Edged Sword: Child Externalizing Behaviors and Parental Stress in a Partial Hospitalization Program

5.30 The Double-Edged Sword: Child Externalizing Behaviors and Parental Stress in a Partial Hospitalization Program

Does Timing Matter? Associations Between Intimate Partner Violence Across the Early Life Course and Internalizing and Externalizing Behavior in Children.

The association between exposure to intimate partner violence (IPV) and child behavior problems is well established. However, questions remain about whether the timing during the child's early life course matters. We used a structured life course approach to investigate associations between the timing of IPV and children's internalizing and externalizing behaviors. Participants were from the Australian Longitudinal Study on Women's Health (ALSWH), a national, randomly sampled community-based study that has surveyed women every 3 years since 1996. For this study, mothers born 1973 to 1978 (N = 2,163) provided data on their three youngest children under 13 years (N = 3,697, 48.5% female) as part of the Mothers and their Children's Health (MatCH) study in 2016/2017. Mothers indicated IPV in ALSWH using the Community Composite Abuse Scale in early (M = 0.99 years, SD = 0.88 years) and middle childhood (M = 3.98 years, SD = 0.92 years), and before birth (preconception). Mothers rated child internalizing and externalizing behavior in MatCH (child age: M = 8.15 years, SD = 2.37 years) using the Strengths and Difficulties Questionnaire. We tested critical period, sensitive period, and accumulation hypotheses by comparing the fit of nested linear regression models (separately for girls and boys). Mothers were predominantly Caucasian (>90%) and university educated (65.5%), and 41.7% reported financial stress. Most children were not exposed to IPV (68.1%). Of those who were, 55.2% were exposed at one time, 28.7% at two times, and 16.1% at all three. Accumulation was the best model for externalizing in boys and girls and for internalizing in girls. A critical period in middle childhood was identified for internalizing in boys. Overall, the duration of exposure was more important than the timing. This suggests early detection is essential in mitigating the impact of IPV on children, with particular attention needed for boys exposed to IPV in middle childhood.

Using Daily Diary Assessments to Better Understand the Role of Parental Consistency in the Development of Externalizing Child Behavior

Consistent discipline is thought to reduce early child externalizing behavior. It is unclear, however, whether consistency is important mainly within episodes of misbehavior (e.g., threatening with discipline but then giving in) or across episodes of misbehavior (e.g., disciplining each instance of misbehavior). Using a daily diary approach, we examine whether these two types of consistency are associated with disruptive child behavior, concurrently and prospectively. We included two samples (Sample 1: N = 134, Magechild = 30 months, 44% girls; Sample 2: N = 149, Magechild = 5.88 years; 46% girls, at-risk sample) with daily reports of child disruptive behavior and parental responses (Sample 1 = 7 days; Sample 2 = 14 days). Sample 1 parents additionally reported on their reactions over the past month and their child’s externalizing behavior one year later. Within-episode consistency was assessed by the average number of parental reactions per episode; across-episode consistency by the Index of Qualitative Variation; and general consistency by parents’ report of how they had responded to child disruptive behavior in the past month. In both samples correlations between within- and across-episode consistency were significant, but not so strong that they were not differentiated. Again in both samples, regression analyses provided evidence for unique predictive value of across-episode, not within-episode, consistency for daily disruptive behavior. Parental general consistency was longitudinally associated with fewer externalizing problems, whereas within- and across-episode consistency were not. It appears meaningful to differentiate within- from across-episode consistency to better understand the relevance of different aspects of consistency.

Elementary Classroom Views of Nature Are Associated with Lower Child Externalizing Behavior Problems.

Exposure to nature views has been associated with diverse mental health and cognitive capacity benefits. Yet, much of this evidence was derived in adult samples and typically only involves residential views of nature. Findings from studies with children suggest that when more greenness is available at home or school, children have higher academic performance and have expedited attention restoration, although most studies utilize coarse or subjective assessments of exposure to nature and largely neglect investigation among young children. Here, we investigated associations between objectively measured visible nature at school and children's behavior problems (attention and externalizing behaviors using the Brief Problem Monitor Parent Form) in a sample of 86 children aged seven to nine years old from 15 classrooms across three schools. Images of classroom windows were used to quantify overall nature views and views of specific nature types (sky, grass, tree, shrub). We fitted separate Tobit regression models to test associations between classroom nature views and attention and externalizing behaviors, accounting for age, sex, race/ethnicity, residential deprivation score, and residential nature views (using Google Street View imagery). We found that higher levels of visible nature from classroom windows were associated with lower externalizing behavior problem scores, after confounder adjustment. This relationship was consistent for visible trees, but not other nature types. No significant associations were detected for attention problems. This initial study suggests that classroom-based exposure to visible nature, particularly trees, could benefit children's mental health, with implications for landscape and school design.

Parenting self-efficacy in relation to children’s executive function and externalizing behavior

Parenting has a prominent role in predicting children’s externalizing behaviors (EB). Although parenting behavior has been shown by prior research to mediate the relationship between parenting self-efficacy (PSE) as the cognitive aspect of parenting and child EB, the role of children’s cognitive aspects in the relationship is not yet well understood. To improve understanding of the relationship between PSE, children’s EB, and children’s cognitive aspect, the current study aims to investigate the mediating effect of children’s executive function (EF) on the relationship between PSE and children’s EB in early childhood. Questionnaire data on PSE, child EF, and child EB were collected from 217 mothers of typically developed children aged 3 years to 8 years in Indonesia. Hayes PROCESS analysis revealed an indirect effect of maternal PSE on child EB that is mediated by child EF when socioeconomic status is controlled. With this indirect effect accounted for, the direct effect of maternal PSE on child EB disappears, suggesting a full mediation effect. Specifically, the relationship between PSE and child EB is fully mediated by inhibitory control, but only partially mediated by working memory. The discovery indicates that children’s EF deficit may increase child EB, along with a decrease in maternal PSE. These findings imply that in providing EB intervention for children, it is necessary to consider PSE and children’s EF.

Examining Influences on Problem Recognition and Help-Seeking for Child Externalizing Behaviors Among African American Mothers

Childhood behavior problems are one of the most common clinical referrals. If left untreated, these behaviors can result in detrimental consequences to the child’s development (Wehmeier et al., 2010; Scholtens et al., 2012). Behavior parent training has been identified as first-line treatment for oppositional behavior; however, many racial minority families fail to enroll in behavior parent training. The current study examines maternal help-seeking for children displaying oppositional behavior in hopes to delineate variables that might influence parent training enrollment among African American families. Participants were 112 African American mothers who were provided child behavior vignettes and completed measures assessing factors related to problem recognition, parental attributions, child rearing values, mental health stigmatization, racial identity, and treatment utilization. Results found that when presented with a child displaying clinically significant externalizing child behaviors, slightly more than half of African American mothers recognized clinically significant child behavior problems. Mothers were more likely to engage in behavioral parent training if problematic behavior was recognized. Additionally, mothers’ attributions of child behavior, cultural values, and mental health stigmatization were influential to help seeking. This study supports the importance of considering cultural variables that impact problem recognition and subsequent treatment utilization among African American families.

Influence of Child Externalizing Behavior on Friendship Centrality and Reciprocity in Kindergarten Classrooms

In this study, we examine friendship centrality and reciprocity between kindergarteners who exhibit externalizing classroom behaviors and their classroom peers. Teachers nominated children who display externalizing classroom behaviors, and we collected network data via individual interviews of 411 children (mean age = 6.7 years; SD = .33) from 21 kindergarten classrooms in four U.S. schools. We found that children nominated for elevated levels of externalizing behavior were significantly less central to the classroom friendship network (over and above the contribution of language skills), and this effect was magnified for boys and students in larger classrooms. Moderator analyses revealed a significant gender by behavior interaction, where the difference between boys and girls was conditional on externalizing behavior nomination. Similar main effect results were found when predicting whether or not students had a reciprocal friendship tie. Students who received a teacher nomination for externalizing behavior had 48% lower odds of having a reciprocal friendship tie, after controlling for language skills. We found no significant moderators of the behavior–reciprocity relation. We conclude our study with a discussion of our findings and recommendations for future research and practice.

Parental Rejection and School-aged Children's Externalizing Behavior Problems in China: The Roles of Executive Function and Callous-unemotional Traits.

This study examined the mediating role of children's executive function (EF) in the relation between parental rejection and children's externalizing behavior problems and whether this mediation varies depending on their callous-unemotional (CU) trait levels. Two hundred and eighty-four Chinese school-aged children and their fathers and mothers participated. Both fathers and mothers reported on parental rejection, children's externalizing behavior problems, EF, and CU traits. The results showed that EF mediated the association between parental rejection and externalizing behavior problems. Moreover, the negative link between EF and externalizing behavior problems was moderated by CU traits; in particular, the combination of higher-level CU traits and lower-level EF predicted more externalizing behavior problems. Our findings point to the importance of considering family context and multiple personal factors simultaneously to decrease children's behavior problems.

Does caregivers' use of praise reduce children's externalizing behavior? A longitudinal observational test in the context of a parenting program.

Caregivers are often encouraged to praise children to reduce externalizing behavior. Although several theoretical perspectives suggest that praise works (e.g., praise reinforces positive behavior), others suggest it may not (e.g., children dismiss praise or experience it as controlling). This longitudinal-observational study examined whether (a) caregivers' praise and children's externalizing behavior were related; (b) an evidence-based parenting program increased caregivers' praise; (c) and increasing praise reduced children's externalizing behavior. Participants (387 caregiver-child dyads) were randomly assigned to a 14-session parenting program (aiming to improve parenting behavior, partly via praise) or a control group. Children (aged 4-8 years, 45% girls) scored at or above the 75th percentile on externalizing behavior problems. Caregivers (91% Caucasian, 85% born in the Netherlands, 50.5% highly educated) were mostly mothers (91%). At baseline, postintervention, and follow-up, we assessed caregivers' labeled and unlabeled praise via in-home observations, and children's externalizing behavior via caregiver-reports and observations. At baseline, caregivers' unlabeled praise was related to more (rather than less) externalizing behavior. The parenting program successfully increased praise and reduced caregiver-reported (but not observed) externalizing behavior; importantly, however, praise did not mediate the program's effect on caregiver-reported externalizing behavior. Although the program did not directly reduce observed externalizing behavior, it did so indirectly via labeled praise. Our results suggest that, although praise and externalizing child behavior are related, praise may not be a key mechanism underlying the effects of the parenting program. If praise has beneficial effects on children's externalizing behavior, these effects are probably limited to labeled praise. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Longitudinal Approach to the Relationships Among Sleep, Behavioral Adjustment, and Maternal Depression in Preschoolers.

This study aimed to investigate the longitudinal associations between children’s sleep duration (SD) and problems (SPs), behavioral adjustment [externalizing behaviors (EB) and internalizing behaviors (IB)], and maternal depressive symptoms (MDS) in preschoolers over a period of 3 years (4–6 years of age). For this purpose, latent growth modeling (LGM) was conducted using 2012(W5) to 2014(W7) data from the National Panel Study on Korean Children (PSKC), while controlling for family contextual factors (i.e., responsive parenting, developmental stimulations, and marital conflict) and child temperament (children’s negative emotionality). First, children who slept longer at four were concurrently associated with lower levels of EB, while more SPs were associated with higher levels of EB and IB, concurrently. Second, greater decreases in SPs were associated with greater decline in EB and IB. Higher levels of MDS at four were associated with higher levels of child EB, IB, and SPs, concurrently. However, no longitudinal associations were found between the rates of change in MDS and children’s sleep and adjustment (EB and IB). Finally, the magnitude of the associations among the variables was greater overall in the SPs models than in the SD models. These findings suggest that addressing sleep problems, rather than sleep duration, seem to be more important in predicting and preventing young children’s adjustment problems and also that more attention should be paid to MDS during preschool years as much as during the postpartum period for better child adjustment outcomes.

Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline.

Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). VIPP-SD combines support of parental sensitive responsiveness with coaching parents in sensitive limit setting. Here, we present meta-analyses of 25 RCTs conducted with more than 2,000 parents and caregivers. Parents or children had various risks. We examined its effectiveness in promoting parental cognitions and behavior regarding sensitive parenting and limit setting, in promoting secure child-parent attachment, and reducing externalizing child behavior. Web of Science, MEDLINE, PubMed, and recent reviews were searched for relevant trials (until May 10, 2021). Multilevel meta-analysis with META, METAFOR, and DMETAR in R took account of the 3-level structure of the datasets (studies, participants, measures). The meta-analyses showed substantial combined effect sizes for parenting behavior (r = .18) and attitudes (r = .16), and for child attachment security (r = .23), but not for child externalizing behavior (r = .07). In the subset of studies examining effects on both parenting and attachment, the association between effect sizes for parenting and for attachment amounted to r = .48. We consider the way in which VIPP-SD uses video-feedback an active intervention component. Whether VIPP-SD indeed stimulates secure attachment through enhanced positive parenting remains an outstanding question for further experimental study and individual participant data meta-analysis.

Child externalising and internalising behaviour and parental wellbeing during the Covid-19 pandemic

In this study we surveyed families' experiences with parental depression, stress, relationship conflict and child behavioural issues during 6 months of the coronavirus (Covid-19) pandemic through the Covid-19: Global Social Trust and Mental Health Study. The current analyses used data collected from online surveys completed by adults in 66 countries from 17 April 2020 to 13 July 2020 (Wave I), followed by surveys 6 months later at Wave II (17 October 2020-31 January 2021). Analyses were limited to 175 adult parents who reported living with at least one child under 18 years old at Wave I. Parents reported on children's level of externalising and internalising behaviour at Wave I. At Wave II, parents completed self-reported measures of stress, depression and inter-partner conflict. Child externalising behaviour at Wave I significantly predicted higher levels of parental stress at Wave II, controlling for covariates. Child internalising behaviour at Wave I did not predict parental stress or depression, controlling for covariates. Neither child externalising nor internalising behaviour predicted parental relationship conflict. The overall findings demonstrate that child behaviour likely influenced parental stress during the Covid-19 pandemic. Findings suggest that mental health interventions for children and parents may improve the family system during times of disaster.

Structure of Child Externalizing Behavior and Associated Parental Stress in Family Situations

All three cardinal symptoms of attention deficit hyperactivity disorder (ADHD) describe impaired stimulus control over behavior. Children with ADHD require more frequent and explicit behavioral cues from others and thereby increase parental stress. Both self-control deficits and parental stress manifest depending on the situation and possess intra-individual variability. Common measures of externalizing behavior and parental stress rarely address this and target generalized impressions instead. Intraindividual differences in externalizing and stressful child behavior can be assessed with a family situations inventory including two rating scales. It rests on the HSQ and supplements the original with a parental stress scale. Method: Parents of children with (male = 204, female = 33; mean = 8.6 years) and without confirmed ADHD (male = 206, female = 155; mean = 7.6 years) took part. They were asked to rate 16 family situations concerning the extent of child externalizing behavior and their own associated stress. Three established scales (CBCL, PSI, BAP) were employed in the clinical sample to determine the external validity of the German HSQ adaption. Results: Both HSQ scales share the same two-factorial structure with satisfying explained variance (56.02–60.38%) and acceptable external and discriminant validity. “Accomplishments” (factor 2) discriminates better than “agreeableness” (factor 1) between children with and without ADHD. Discussion: “Accomplishments” refers to behavior in regularly recurring situations and demands rule following. Parental stress associated with child externalizing behaviors in family situations appears to represent regulation load rather than mental load.