Externalizing Behavior Problems Research Articles

Therapist alliance building behavior and treatment adherence for dutch children with mild intellectual disability or borderline intellectual functioning and externalizing problem behavior

BackgroundPsychological interventions targeting children with mild intellectual disability or borderline intellectual functioning (MID-BIF) are suggested to be effective in reducing their externalizing problem behavior, but less is known about the specific treatment processes that may be associated with these effects. AimsThe current study investigated whether the treatment processes of observed treatment adherence (i.e., the degree to which a therapist sticks to the protocol of a treatment and provides the treatment as intended) and observed therapist alliance-building behavior (TA-BB; i.e., behavior contributing to the affective bond between the therapist and the client) predicted treatment outcomes in a group behavioral parent training combined with group child cognitive behavior therapy targeting externalizing problem behavior in children with MID-BIF. Methods and proceduresSeventy-two children (aged 9–18; Mage = 12.1) and their parents in The Netherlands received the intervention program. They reported on children’s externalizing behavior, parenting practices and the parent-child relationship by questionnaires at pre-test and post-test, and the observed treatment processes were coded by audio tapes of therapeutic sessions. Outcomes and resultsThe results showed high levels of both treatment adherence (M = 2.49; SD = 0.20; range 1 – 3) and TA-BB (M = 4.11; SD = 0.32; range 1 – 5). Additionally, repeated measures analyses revealed that levels of treatment adherence significantly predicted the improvement of the parent-child relationship (F(1, 66) = 5.37; p = .024) and that levels of TA-BB significantly predicted the decrease of parent reported externalizing problem behavior (F(1, 66) = 9.89; p = .002). Conclusions and implicationsThe current study suggested that optimal treatment processes are important for treatment outcomes in an intervention targeting children with MID-BIF.

The efficacy of a self-help parenting program for parents of children with externalizing behavior: a randomized controlled trial

Parenting programs are effective for children with externalizing problems, but not always easily accessible for parents. In order to facilitate accessibility, we developed a self-help parenting program, consisting of a manual and online part. The efficacy of the program in reducing children’s externalizing problems was compared to waitlist in a randomized controlled trial. In addition, two versions of the program were exploratively compared, one with and one without biweekly telephonic support. Candidate moderators (child and parent factors) and parental satisfaction were also examined. We randomly assigned 110 families to one of the following three conditions: the support condition, the no support condition, or the waitlist condition. Intervention duration was 15 weeks. Outcomes were collected at baseline (T0), 8 weeks (T1), 15 weeks (T2), and 28 weeks (T3) and included daily telephonic measurements of parent-rated externalizing behavior and the Intensity scale of the parent-rated Eyberg Child Behavior Inventory (ECBI). Main analyses compared outcomes at T2, using longitudinal regressions with T0 as fixed factor. Results showed that children improved significantly more on both outcomes in the intervention condition compared to waitlist, with small to medium effect sizes. Parental satisfaction was high. Neither differences in efficacy nor in parental satisfaction were found between the support and no support condition. No moderators were detected. The newly developed self-help parenting program is effective in reducing children’s externalizing behavior problems and may help improve access to evidence-based care.

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.

Exploring Bidirectional Language–Behavior Influences for Spanish–English Dual Language Learning Children in Head Start

The purpose of this exploratory study was to examine the longitudinal, bidirectional relations between receptive and expressive Spanish and English language and internalizing and externalizing behavior problems in a sample of 97 preschool children from Spanish-speaking, homes who were enrolled in a U.S. Head Start program. Eight cross-lagged path models were conducted: four for each language. Models tested the autoregressive and cross-lagged paths between two dimensions of language (expressive and receptive) and behavior problems (internalizing and externalizing) over the preschool year. Findings highlight the critical importance of the home language for children who are dual language learners and suggest programs ensure adequate home language support is available in the classroom. Future directions are discussed.

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).

Witnessing intimate partner violence and cyberbullying among Chinese adolescents: The mediating effect of self-control and moderating effect of parental psychological control

Witnessing intimate partner violence (IPV) is associated with adolescents’ externalizing behavior problems such as bullying and aggression, but its association with cyberbullying perpetration remains unclear. Given the prevalence of cyberbullying perpetration, this study aims to examine the relationship between witnessing IPV and cyberbullying perpetration, and also to explore whether self-control mediates, and parental psychological control (PPC) moderates the association. 1,670 primary and junior high school students (aged from 10 to 15 years, 53.7% boys) in China participated in the questionnaire survey in May, 2017. The results showed that witnessing IPV positively predicted cyberbullying perpetration significantly when sex and grade were controlled. Self-control partially mediated the relationship between witnessing IPV and cyberbullying perpetration, while PPC moderated the relation between witnessing IPV and cyberbullying perpetration. Specifically, the effect of IPV on cyberbullying perpetration was stronger when PPC was high compared to when PPC was low. Multi-group analysis showed that the effect of witnessing IPV on cyberbullying perpetration was stronger in boys than in girls and the mediation effect of self-control was stronger among junior high school students than among primary schools. The implications for intervention of cyberbullying perpetration are discussed.

Executive function training for kindergarteners after the Great East Japan Earthquake: intervention effects

Japan’s Social Thinking and Academic Readiness Training (START) program Academic Readiness (AR) lesson aims to improve self-regulation, executive function, and behavior problems in kindergarten children, but the effects of the START program AR lessons in unfavorable circumstances are unclear. Therefore, this study investigated the effects of the START program AR lesson in affected areas after the Great East Japan Earthquake. A cluster randomized trial was conducted with 111 5-year-old children in two kindergartens in Miyagi Prefecture to evaluate the effectiveness of the six-week AR lesson. One kindergarten was randomly chosen to implement the AR lesson, and the other maintained standard education. In the intervention group, trained classroom teachers provided the children with a 20-min AR lesson once a week. Executive function, behavioral self-regulation, and internalizing and externalizing problem behaviors were measured before and after the six-week intervention. The intervention group showed improved inhibitory control and enhanced behavioral self-regulation compared with the standard practice group. In addition, teachers’ evaluations showed that children’s internalizing and externalizing problem behaviors improved significantly. The results indicate that the START program AR lesson was effective in enabling teachers to help students improve executive function, self-regulation, and problematic behaviors. Therefore, educators and policy-makers should consider implementing the START program AR lesson in kindergartens after a disaster.

Impact of COVID-19-related Stress on Preschool Children's Internalizing and Externalizing Problem Behaviors: The Indirect Effect of Mother's Depression and Parenting Behavior.

The COVID-19 pandemic is affecting families and children worldwide. Experiencing the pandemic leads to stress in families resulting from fear of infection and social isolation derived from social distancing. For families raising preschoolers, the prolonged closure of childcare centers puts additional childcare burden on family members, especially mothers. Due to the limited research exploring the impact of COVID-19 on preschool children’s problem behaviors, this study examines the association between stress due to COVID-19 and preschool children’s internalizing and externalizing problem behaviors related to mother’s depression and parenting behavior. The study sample included data collected from 316 South Korean mothers raising preschool-aged children aged 3 to 5. The study findings suggest that mother’s COVID-19 stress was indirectly associated with preschool children’s internalizing and externalizing problem behaviors resulting from the mother’s depression and parenting behaviors, although the direct effect of COVID-19 stress on preschool children’s outcomes was not statistically significant. Increase in mother’s COVID-19 stress was associated with increase in depression, and sequentially decreased positive parenting behaviors, which in turn resulted in preschool children’s internalizing and externalizing problem behaviors. The study findings highlight the need to focus on enhancing mental health of mothers and preschool children’s adjustment by implementing supportive interventions to reduce the adverse impacts of the prolonged COVID-19 pandemic.

The role of anxiety and callous-unemotional traits in the relationship between externalizing behaviors and sleep problems in clinic-referred youth.

In a growing body of literature, poor sleep quality has been associated with externalizing problems. In adults, anxiety was found to mediate the relationship, and callous-unemotional (CU) traits were found to moderate it. We sought to examine these relationships in a child population. We examined these relationships in 239 clinic-referred youth (age 6-17) in Singapore with externalizing behavior problems. Parent- but not child-rated sleep problems were associated with increased parent-rated externalizing problems. This association was partially mediated by anxiety. Unlike in adults, CU traits did not moderate the relationship. Sleep problems were associated with externalizing problems regardless of the level of CU traits. It is possible externalizing behaviors may lead children to internalize experiences, leading to anxiety about their behaviors. Another possibility is externalizing behaviors may lead to more stressful life experiences due to negative reactions children with externalizing behaviors receive from parents, teachers, or peers. Regardless, the partial mediation found indicates anxiety may be an important factor to consider in future interventions focused on improving sleep as a means to reduce externalizing problems.

Experiences of helplessness and fear among caregivers diagnosed with severe mental illness and co-caregivers: The Danish High Risk and Resilience Study - VIA 7.

This study investigates indicators of disorganized caregiving among caregivers of children who have a familial predisposition of schizophrenia spectrum psychosis (SZ) or bipolar disorder (BP), and whether indicators of disorganized caregiving are associated with the caregivers' and children's level of functioning as well as the children's internalizing and externalizing behavior problems. Indicators of disorganized caregiving were assessed with the Caregiving Helplessness Questionnaire (CHQ). Level of functioning was evaluated using the Children's Global Assessment Scale and the Personal and Social Performance Scale, while dimensional psychopathology were measured with the Child Behavior Checklist. 185 caregivers belonging to a SZ combined group (i.e., SZ-I + SZ co-caregiver), 110 caregivers to a BP combined group (i.e., BP-I + BP co-caregiver), and 184 caregivers to a population-based control group provided data on CHQ. Having a history of SZ or BP or being a co-caregiver to a parent with SZ or BP was associated with higher levels of experiences of helplessness and fear. Higher scores on helplessness were associated with lower level of functioning among caregivers and children and with children having externalizing/internalizing behavior problems. These results emphasize the need for interventions addressing indicators of disorganized caregiving in families with SZ or BP.

Intergenerational Continuity of Risk: Examining Pathways From Parental Mental Health to Children’s Behavioral Health Problems Among Families Investigated for Maltreatment

Objective: Children exposed to maltreatment are a vulnerable population with disproportionately high rates of adverse outcomes, including internalizing and externalizing behavior problems. Parental risk characteristics, such as poor mental health, may help to explain the health and developmental trajectories of children who have experienced maltreatment. This study examined the hypothesis that specific parenting behaviors mediate the association between parental mental health and children’s behavioral health outcomes among families investigated for maltreatment. Method: We used data from parent interviews from Waves 1 and 3 of the National Survey of Child and Adolescent Well-Being II (N = 1,192) to measure parenting behavior pathways from parental mental health to children’s behavioral health. Results: Path analyses indicated statistically significant direct effects of poor parental mental health on neglectful, psychologically aggressive, and physically assaultive parenting and on children’s internalizing and externalizing behavior problems. We found statistically significant indirect effects from poor parental mental health to internalizing behavior problems through neglectful and psychologically aggressive parenting, and from poor parental mental health to externalizing behavior problems through psychologically aggressive parenting. Conclusion: Results suggest that specific parenting behaviors partially mediate the relationship between parental mental health and children’s behavioral health outcomes. Findings suggest the need to target specific parenting behaviors to reduce children’s internalizing and externalizing behavior problems and promote health and development across generations.

Prenatal environment and developmental trajectories: the intrauterine growth restriction.

The prenatal environment is of fundamental importance for the fetus, as the fetus is particularly susceptible to environmental influences while in utero, and several prenatal adversities may constitute a risk factor for fetal growth and child development. Intrauterine growth restriction (IUGR) refers to a pregnancy complication involving the inadequate growth of the fetus in utero, with potential programming consequences on the children's brain-behavior development. In this narrative review we will discuss the most recent literature about IUGR children, including their development and their relationship with the prenatal and postnatal environment. In particular, as an attempt to an adaptive response to intrauterine changes, the brain development of IUGR fetuses follows abnormal developmental pathways, which likely has cascade effects on the future neurodevelopmental outcomes of the children. Cognitive and motor functions are in fact impaired, as well as IUGR children present, across studies, poor socio-emotional abilities and a greater risk for internalizing and externalizing behavior problems. The current work also highlights how the postnatal environment, and in particular parental care, has an important role in IUGR development, acting as a protective factor, or otherwise increasing their constitutional vulnerabilities. Overall, this narrative review has important implications for clinical practice, suggesting the need for long-term follow-up care with IUGR children and strategies supporting parent-child interactions as well.

Association of Antenatal Micronutrient Supplementation With Adolescent Emotional and Behavioral Health: A 14-Year Follow-Up of a Double-Blind Randomized Controlled Trial

Abstract Objectives To examine the impact of antenatal micronutrient supplementation on adolescent emotional and behavioral health, and to identify the modifying effect of household wealth. Methods We conducted a double-blind cluster-randomized trial of antenatal micronutrient supplementation in rural western China between 2002 and 2008. Pregnant women in every village were randomized to daily take one capsule of folic acid (as control), folic acid plus 60 mg iron (IFA), and multiple micronutrients (MMNs) including 30 mg iron. Singleton births were prospectively followed at early adolescence in 2016. Adolescents actively completed the localized and qualified Youth Self-Report. Scores of Internalizing Behavior Problems (constituting by Anxious/Depressed, Withdrawn and Somatic Complaints), Externalizing Behavior Problems (constituting by Delinquent/Rule-Breaking Behavior and Aggressive Behavior) and Total Behavior Problems, were derived. As priorly specified, we examined the modifying effect of household wealth on the response to antenatal IFA and MMNs vs. folic acid supplementation on adolescent emotional and behavioral health. Results Of 1920 adolescents included in the final analysis, 1130 (58.9%) were male, with a mean (SD) age of 11.8 (0.78) years. As compared to folic acid, adolescents born to mothers who consumed IFA had lower scores of total behavioral problems, externalizing, rule-breaking and aggressive behavior. The adjusted mean differences were −2.94 (95% CI −5.78, −0.11), −1.00 (95% CI −1.82, −0.18), −0.39 (95% CI −0.73, −0.05) and −0.61 (95% CI −1.15, −0.07), respectively. Similar associations were observed among medium-wealth households, while null associations in low-wealth households (all interaction P values < 0.05). Further, among high-wealth households, MMNs show benefits on reducing the risk of adolescent behavioral problems as compared to IFA or folic acid. Conclusions Sufficient iron intake in pregnancy has long-term benefits on reducing the risk of adolescent behavioral problems. Multiple micronutrients including 60 mg iron are recommended in rural areas with micronutrients deficiencies widely prevalent given the benefits of MMNs on improving birth outcomes. Funding Sources National Natural Science Foundation of China and China Postdoctoral Science Foundation.

Effectiveness of an emotion focused cognitive-behavioral therapy (ECBT) program for externalizing disorders in children and adolescents : clinical profile

IntroductionExternalizing disorders involve undercontrolled, impulsive, or aggressive behavior. Included in this category are Conduct Disorder, Oppositional Defiant Disorder, and Attention deficit hyperactivity. Difficulties with emotion regulation are a core feature of externalizing disorders in children and adolescents. Yet, no studies to date have compared the relative efficacy of an ECBT program in this population.Objectivesto investigate the effectiveness of an ECBT inspired program in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD)MethodsWe conducted an experimental study with a pretest posttest design and a control group. 50 subjects with either ADHD, ODD or CD were selected and assigned to the experimental and control group. 25 patients ages 9–18 (13 boys, 12 girls) were enrolled in the ECBT-inspired program with 19 completing treatment. Comparison of pre- and post-test results for each sub-group was performed using the Wilcoxon test.Resultsshowed that youths in the ADHD and ODD groups demonstrated a significant reduction in externalizing behavior problems measured by the Child Behavior Checklist (CBCL). In terms of emotional regulation, only the group of patients with ODD showed a significant improvement in the cognitive reappraisal subscale of the emotional regulation questionnaire(ERQ- CA ). Only in the ODD group, significant improvement was found in the identification and external oriented thniking subscale scores of the alexithymia questionnaire for children (AQC).ConclusionsSuch comparisons are necessary to determine the clinical profile of patients who might most benefit from such an intervention.DisclosureNo significant relationships.

Effects of Co-parenting and Infant Emotional Self-Control on the Externalized Problem Behavior of Infants

Objectives: The main purpose of this study was to examine the direct and indirect effects of coparenting, infants’ emotional self-control, and infants’ externalized problem behaviors.Methods: A total of 281 mothers of infants aged 3-5 years responded to questionnaires on three research variables. The scale used in this study was first measured using a co-parenting questionnaire, the emotional regulation checklist (ECR), and the child behavior checklist (CBCL). Data were analyzed with structural equation modeling using SPSS 21.0 and AMOS 20.0.Results: The correlations between co-parenting, infants’ emotional self-control, and externalized problem behaviors were all statistically significant. With regard to the direct impact of co-parenting on infant problem behavior, co-parenting had a significant impact on infant externalized problem behavior. Co-parenting also indirectly influenced the externalized problem behaviors in infants through the infants’ emotional self-control.Conclusion: This study demonstrated the importance of co-parenting and infant’s emotional selfcontrol. The results suggest the need for a parent education program to improve infants’ emotional selfcontrol and could be used as basic data for counseling and parent education sites to develop parenting programs to prevent infant problem behavior and ultimately create an enviroment that positively affects infant development.

Maternal use of corporal punishment and behavior problems in early childhood: A sibling comparison analysis

BackgroundPrevious research demonstrates that there are environmental and genetic factors associated with the use of corporal punishment (CP) and children's behavior problems. Thus, it is difficult to disentangle whether CP has a causal effect on children's developmental outcomes. ObjectiveThis study explored the relationship between maternal use of CP at ages 3–4 years and symptoms of internalizing and externalizing behavior problems between the ages of 6 and 9 years using a sibling comparison design. In doing so, we were able to control for shared environmental factors and partially control for genetic factors that could explain the relationship between CP and behavior problems. MethodsThis study analyzed data from 11,506 children from the United States. We used generalized linear models to assess the relationship between the use of CP and behavior problems among biological siblings raised in the same home. ResultsAt the population level, CP was significantly associated with the development of internalizing behavior problems (β = 0.134, SE = 0.03, p < .001). When comparing siblings, this relationship was no longer significant. In contrast, CP was significantly associated with externalizing behavior problems at both the population (β = 0.233, SE = 0.02, p < .001) and sibling comparison level (β = 0.107, SE = 0.03, p < .001). ConclusionWe did not find evidence to suggest that the association between CP and externalizing behavior problems is due to environmental and genetic factors exclusively. Corroborating previous research, these results suggest that CP may increase the likelihood of externalizing behavior problems.

The role of socioemotional wellbeing difficulties and adversity in the L2 acquisition of first-generation refugee children

AbstractFirst-generation refugee children often experience pre- and post-migration adversity and display high levels of mental health/wellbeing difficulties, but to date, research has not examined the impact of such factors on refugee children's L2 acquisition. Accordingly, this study examined the influence of externalizing and internalizing problem behaviours (wellbeing), time in refugee camps and low socioeconomic status (SES) (adversity) on the English-L2 abilities of 117 Syrian refugee children (7–14 years) in their third year of residency in Canada. Wellbeing difficulties and adversity factors accounted for variance on L2 vocabulary, morphosyntax, listening comprehension and narrative production tasks, beyond the variance accounted for by age of L2 acquisition and length of L2 exposure. Specifically, externalizing problem behaviours, time in refugee camp, maternal education and maternal employment predicted variance in L2 abilities. It is concluded that refugee children could have influences on their L2 acquisition that are different from those of bilinguals with other backgrounds.

The Influence of Parent-grandparent Co-parenting on Children’s Problem Behaviors and Its Potential Mechanisms

ABSTRACT This study aimed to examine the influence of parent-grandparent co-parenting on children’s problem behaviors and its potential mechanisms. Participants were 412 children aged 3 to 6 years from four kindergartens in Shanghai, China. Their mothers were asked to complete a series of questionnaires including the parent-grandparent co-parenting scale, parenting style scale, parent-child relationship scale, and their grandparents were asked to complete children’s behavior evaluation scale. Research Findings: The results showed that: (1) Supportive co-parenting was associated with less internalizing and externalizing problem behaviors in preschool children, and unsupportive co-parenting was associated with more internalizing and externalizing problem behaviors; (2) Supportive parent-grandparent co-parenting was negatively associated with children’s internalizing and externalizing problem behaviors mainly through maternal authoritative parenting and mother-child conflict, and unsupportive parent-grandparent co-parenting was positively associated with children’s internalizing and externalizing problem behaviors mainly through maternal authoritarian parenting and mother-child conflict, or directly through mother-child conflict. Practice or Policy: These findings provide valuable information on the importance of parenting styles and parent-child relationships between parent-grandparent co-parenting and children’s problem behaviors in Chinese culture.

Neonatal stress and behavior problems in preschool children born preterm.

The aim of the present longitudinal study was to examine the effect of preterm childbirth, acute neonatal stress, and child behavior at 18-36months of age on later behavior outcomes in 4-5-year-old children. The sample comprised of 70 children who were born preterm. The neonatal characteristics of children were assessed during hospitalization by reviewing their medical records and utilizing the Neonatal Infant Stressor Scale. Behavior problems were evaluated by the maternal-report in the Child Behavior Checklist 1½-5years. A multiple linear regression analysis was conducted. Also, the repeated measures analysis of variance and the McNemar test for paired samples were performed. Daily exposure of the infants to high neonatal acute stress during NICU hospitalization and more behavior problems at 18-36months of age was associated with more total and externalizing behavior problems at 4-5years of age. Lower gestational age at childbirth and more internalizing behavior problems at 18-36months was associated with more internalizing problems at 4-5years old. The present study showed the combination of predictors of neonatal conditions and behavioral problems at childhood, highlighting the relevance of the implementation of developmental care in the NICU and follow-up the preterm infants after discharge programs.

Mind-mindedness and preschool children's behavioral difficulties: The moderating role of maternal parenting distress.

Mind-mindedness (MM) is a caregiver's tendency to appreciate their infant's internal mental states. This longitudinal study investigated whether maternal MM (10 months) was linked with children's later behavioral problems (51 months) and the moderating role of maternal parenting distress (PD; 36 months) in a sample of 91 mother-infant dyads. Appropriate MM comments were coded from video-recorded, semi-structured play interactions between mothers and their infants; PD was obtained from maternal completion of the PD subscale of the Parenting Stress Index - Short Form (PSI-SF); and child internalizing and externalizing behavior problems were gathered from maternal report on the Strengths and Difficulties Questionnaire (SDQ). Moderated regression analyses revealed higher early appropriate MM was associated with significantly fewer internalizing emotional problems at 51 months among mothers with lower PD at 36 months, and higher early appropriate MM was associated with lower conduct problems at 51 months in mothers with higher PD at 36 months. Findings demonstrated the importance of considering nuanced contexts such as at-risk mothers and differential presentations of child difficulties in the analysis of the relationship between MM and child behavioral difficulties and the development of MM interventions.