Higher Levels Of Behavior Problems Research Articles

Family economic stress and preschooler adjustment in the Chinese Context: The role of child routines

Guided by the family stress model, this study tested competing mediating vs moderating hypotheses regarding the role of consistent child routines in the relation between family economic stress and child adjustment (i.e., behavioral problems and social skills). A total of 508 parents of preschool-aged children from China completed measures of family economic stress, child routines, and child adjustment. Structural equation modeling was used to test the mediating and moderating effects of consistency in child routines in separate models. Both models indicated good fit to the data. Specifically, consistency in child routines mediated the relation between economic stress and children’s behavioral outcomes. However, the competing model showed that consistency in child routines did not emerge as a moderator. The present study suggested that parents having a higher level of economic stress had more difficulties in maintaining consistent child routines in the family context, which, in turn, was associated with children’s higher levels of behavioral problems and poorer social skills. Nevertheless, consistent child routines did not buffer the negative effects of family economic stress on child adjustment.

Early Childhood Caries and Its Association With Behavior in Preschool Children.

Background and aim Early childhood caries (ECC) is a profoundly impactful multifactorial condition that not only influences a child's overall well-being but also diminishes their quality of life. Given the limited availability of literature on the relationship between children's behavior and ECC, the present study utilized a standardized assessment tool to assess the association between ECC and behavioral changes in preschool children. Methodology Our study cohort consisted of 120 healthy preschool children, aged 18-60 months, evenly divided into two groups: caries-free (group I) and caries active (group II). Clinical features of ECC were meticulously inspected in each child, and the parents or caregivers completed the Child Behavior Checklist (CBCL), which comprises 100 questions related to a child's daily behavior. The total scores, the narrow-band subscales, and raw scores were obtained. Accordingly, for each raw score, t-scores were obtained using the graphic display. These scores were then subjected to various statistical analyses including the Kolmogorov-Smirnov test, Mann-Whitney U test, and Spearman's rank correlation method. Results Results of the present study revealed that there were no significant differences in behavior based on demographic factors such as gender and age. However notable differences were observed in several aspects of behavior between the two groups. Conclusion Caries-active children exhibited significantly higher levels of behavioral problems compared to their caries-free counterparts.

Beyond Linear Effects: Multiple Perspectives of Mother–Adolescent Positive Parenting & Adolescent’s Problem Behavior

Discrepancies among family members’ ratings on aspects of family functioning are challenging both, methodological and interpretational. Family members’ perspectives and their discrepancies are indicators of family functioning, affecting adolescents’ psychological development. Previous research focused on linear effects, ignoring that rather extreme than the small differences in ratings might be associated with higher levels of problem behaviors, indicating a negative development. Based on 947 German mother-adolescent-dyads, this study examined how level and discrepant parenting ratings on parental warmth relate to early adolescents’ problem behaviors (3rd–6th), using LCSMs to assess the level as well as linear and quadratic discrepancy effects. This study showed that before secondary school-transition, high mother-adolescent levels in parental warmth negatively predicted emotional and social problems. After the transition, very high levels of discrepancies positively predicted problem behaviors, when modelled as quadratic effects. The study not only highlights the consideration of multiple perspectives but also the type of modeling.

Caregiver stress, parenting, and child outcomes among grandfamilies

Over 2.4 million grandparents are responsible for raising their grandchildren (custodial grandparents; CGs). CGs have high levels of stress and many experience financial hardship. Additionally, their grandchildren are vulnerable to psychological disorders. Parenting research has found low-income, child behavioral problems, and stress are clearly linked with dysfunctional parenting strategies. The current study examined how these factors are associated among grandfamilies. 79 CGs of 6- to 12-year-old grandchildren completed measures of general stress, parenting stress, parenting strategies, and child behavior. It was hypothesized that parenting stress would be more strongly correlated with both dysfunctional parenting and child behavioral problems compared to general stress. Further, it was hypothesized that both parenting stress and dysfunctional parenting would predict child behavior and that general stress would not explain additional variance in child behavior. Finally, income was expected to moderate the associations between parenting stress and child behavior, as well as dysfunctional parenting and child behavior. Parenting stress was significantly correlated with parenting and child outcomes, and general stress was similarly associated. Parenting stress and dysfunctional parenting were predictive of child outcomes. However, general stress did explain additional variance in child behavior over and above parenting stress and parenting. Further, income did not moderate the associations of parenting and child behavior, nor parenting stress and child behavior. Consistent with previous research, grandparents’ parenting and general stress were high, grandchildren had high levels of behavioral problems and many families had low-income. Our findings highlight the need for a comprehensive treatment approach when working with grandfamilies.

0637 Associations Between Sleep Quality and Child Behavioral Problems, a Longitudinal Analysis

Abstract Introduction Internalizing and externalizing behaviors are important mental health outcomes in children. Internalizing symptoms are characterized by a disturbance in mood or emotion. Symptoms include loneliness, sadness, anxiety, rumination, and depression. Externalizing symptoms are behaviors that are aversive to others and experienced by other people. Symptoms include aggression, hyperactivity, property destruction, and losing one’s temper. This longitudinal analysis examined how children’s sleep quality related to their internalizing and externalizing behaviors. Methods 246 Children (n = 246 at T1, n = 196 at T2, n = 151 at T3), with a mean age of 9.9 (SD = 1.4) at time one, participated in a longitudinal study on sleep and substance use. Sleep quality was measured with the Adolescent Sleep Wake Scale (range 1-6); higher scores represent better sleep quality. Child internalizing and externalizing behavior problems were measured using the Childhood Behavior Checklist; higher scores indicate higher levels of behavioral problems. The associations between sleep quality, and internalizing and externalizing behavior at T1, T2, and T3 were examined. One year separated each time-point. Data were analyzed by structural equation modeling. Latent variables of sleep quality, internalizing, and externalizing were created from the observed measurements at the three time-points. Latent variables of internalizing and externalizing were regressed on sleep quality. Results The model indicated an excellent fit with the data (χ2 = 21.94, p = 0.46; CFI = 1.00; TLI = 1.00; RMSEA = 0.00). All observed variables loaded significantly onto their respective latent variables, internalizing, externalizing, and sleep quality (p < 0.001). Results indicated that the latent variable of sleep quality predicted both the latent variables of internalizing (b = -0.34, se = 0.09, p < 0.001) and latent externalizing behaviors (b = -0.31, se = 0.08, p < 0.001). Conclusion These results indicate children with better sleep quality have fewer internalizing and externalizing behavioral problems. This suggests that improving sleep quality could improve behavioral problems in children. Alternatively, improving behavioral problems may improve sleep quality. Future research should examine the directionality of this relationship. Future research should also test if sleep or behavioral interventions improve sleep quality and child behavioral problems. Support (if any) NIH Grant R01 AA020364

Parental report of levels of care and needs 7-years after severe childhood traumatic brain injury: Results of the traumatisme grave de l’Enfant (TGE) cohort study

This study investigated parental reports of the level of care and needs 7-years following severe childhood traumatic brain injury (TBI), and the factors associated with this outcome. From the 65 children (0–15 years) consecutively admitted to the Parisian regional TBI reference intensive care unit following severe TBI, included in this prospective longitudinal study, 39 patients [M(SD) age at injury = 7.5 years (4.6) and assessment 15.3(4.4)] were followed 7-years post-injury and matched with a control group composed of typically developing participants (n = 34) matched by age, sex and parental education level. We used the Care and Need Scale (CANS) and its Pediatric version (PCANS) to assess the primary outcome 7-years post-injury. Concurrent measures included overall level of disability, and parent- and/or self-reported questionnaires assessing executive functioning, behavior, quality of life, fatigue, participation and caregivers’ burden. The level of care and needs was significantly higher in the TBI group than in the control group, the difference being significant with the CANS only. PCANS scores were extremely variable in the control group. High level of dependency was associated with initial TBI severity (higher coma duration and initial Injury Severity Score), higher levels of behavioral problems, executive function deficits, fatigue, and lower participation levels. Caregivers’ burden was strongly associated with the CANS. The CANS provides a simple and reliable measure of the support needed long-term after childhood TBI, in accordance with previous studies. The PCANS scores were not significantly different between the TBI and the control groups, which seems to illustrate the difficulty to assess accurately mild-to-moderate deficits of functional independence/adaptive behavior in children based exclusively on parental reports.

Association between caregiver and household alcohol use and child behavior problems in KwaZulu Natal, South Africa.

We explored the association between household alcohol use and behavior problems among South-African children, using data from the Asenze study, a population-based cohort of South African children and their caregivers. Household alcohol use and child behavior were assessed when children were 6-8 years old. To examine the association, we performed linear regressions. The sample included 1383 children with complete data under the care of 1251 adults. Children living in a household where self-reported caregiver alcohol use was scored as hazardous (4.6%) had higher levels of problem behavior (β = 1.94, 95% CI 0.06-3.82). There were no statistically significant associations between reported hazardous alcohol use by another member of the household (14.5%) and child problem behavior. Hazardous household alcohol use was associated with child problem behavior and this effect appeared to be mainly driven by primary caregiver use.

Modelling triadic relationships in families of children with intellectual disability.

BackgroundExisting research has predominately focused on dyadic relationships in families of children with intellectual disabilities. The aim of this study was to build on emerging literature exploring triadic relationships between a mother, sibling, and child with intellectual disability, investigating how they influence each other's well‐being.MethodAn online survey was used to collect information regarding the mother's mental health and the emotional and behavioural problems of the sibling and the child with intellectual disability in 573 families.ResultsUsing structural equation modelling, we found that maternal psychological distress was associated with higher levels of behaviour problems in the sibling, and the behaviour problems of the child with intellectual disability were associated with higher levels of maternal distress.ConclusionsFamily member well‐being is inter‐related in families of children with intellectual disabilities. Clinical interventions that improve the behaviours of children with intellectual disabilities should be considered.

Peer influence on problem behaviors among students with intellectual disabilities

BackgroundStudents with intellectual disabilities (ID) exhibit increased rates of problem behaviors compared to those without ID. AimsGiven the evidence of peer influence in typical development, we examined the impact of classmates’ characteristics on problem behaviors of students with ID. We expected higher levels of problem behaviors in special needs classrooms will influence individual development of such behaviors. MethodsA longitudinal design with measurements at the beginning and the end of a school year was applied. Staff reported on problem behaviors of 1125 students with ID (69 % boys; age 11.30 years,SD = 3.75) attending 16 Swiss special needs schools. ResultsThe peer influence hypothesis was not supported for an overall problem behavior score. However, exploratory analyses suggested that peer influence did occur for the domains anxiety, problems in relating socially, and communication disturbances (not disruptive/antisocial, self-absorbed and other types of problem behaviors). The influence of classmates on anxiety was lower when there was more variability in anxiety within the classroom. The development of communication skills benefitted from attending a classroom that was heterogeneous in the level of communication problems. ConclusionOur results suggest that the influence of peers on problem behaviors in special needs schools is not universal but varies between domains and depends on classroom characteristics.

Mental Health in Early Childhood and Changes in Cardiometabolic Dysregulation by Preadolescence.

Poor mental health in childhood is associated with a greater risk of cardiometabolic disease in adulthood, but less is known about when these associations begin to emerge. This study tests whether poor mental health (indexed by emotional and behavioral problems) in early childhood predicts increases in cardiometabolic dysregulation over 4 years of follow-up. Data are from 4327 participants in the Generation R Study. Problem behaviors were reported by mothers using the Child Behavior Checklist at age 6 years. Repeated measurements of six cardiometabolic parameters were collected at ages 6 and 10 years: high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, systolic and diastolic blood pressures, C-reactive protein, and body mass index. Standardized measures were used to create continuous cardiometabolic dysregulation scores at ages 6 and 10 years. Change in dysregulation was defined as the difference in dysregulation scores over time. Cross-sectional and prospective associations were tested using linear regression, sequentially adjusting for relevant confounders. Additional analyses examined whether prospective relationships were robust to adjustment for baseline levels of dysregulation. There was no association between child problem behaviors and cardiometabolic dysregulation at age 6 years. However, higher levels of problem behaviors predicted increases in cardiometabolic dysregulation (β = 0.12, 95% confidence interval = 0.00-0.23) from ages 6 to 10 years. Worse child mental health may be associated with increases in cardiometabolic dysregulation by preadolescence. To our knowledge, this is the first study to demonstrate that adverse physiologic effects of psychological distress identified in adult populations may be observed as early as childhood.

Childhood resilient personality trajectories and associations with developmental trajectories of behavioral, social-emotional, and academic outcomes across childhood and adolescence: A longitudinal study across 12 years

This study examined the continuity and change of childhood resilient personality (first three years in primary education), and how differential trajectories in resilient personality were dynamically associated with behavioral problems, social-emotional functioning and academic performance across the primary and secondary school years (Grade 1–12). Participants were 784 academically at-risk students predominantly from low SES families (47% girls, 37.4% Latino or Hispanic, 34.1% European American, and 23.2% African American) who were recruited in grade 1 (Mean age = 6.57) and followed annually through the final year of high school (Grade 12). Results revealed three distinct trajectories of childhood resilient personality, including an ego-resilient or flexible group (26.8%), an ego-brittle or inflexible group (21.9%), and an ordinary or common group (49.9%). Children in the ego-brittle group were at a greater risk for sustaining high levels of behavioral problems, low socio-emotional functioning (based on parent and teacher report), and poor academic performance across formal schooling. In contrast, the resilient children exhibited persistently low behavioral problems, high social-emotional functioning, and better academic performance across formal schooling. Findings also indicated that the protective effect of childhood resiliency was sustained even after the transition from childhood to adolescence.

Psychological Adjustment of Children and Adolescents with 22q11.2 Deletion Syndrome and Their Mothers’ Stress and Coping—A Longitudinal Study

At present, there is a lack of longitudinal studies on the psychological adjustment of both children and adolescents with 22q11.2 deletion syndrome (22q11.2DS) and their primary caregivers. To fill this gap, we performed a four-year follow-up study. Mothers filled out the Child Behavior Checklist 4–18, the Social Orientation of Parents with Handicapped Children questionnaire to assess maternal stress and coping strategies, and the Freiburger Personality Inventory-Revised—subscales strain and life satisfaction. Fifty-five subjects with 22q11.2DS (26 males and 29 females; age: M = 10.79 years, SD = 3.56 years) and their biological mothers (age: M = 40.84 years, SD = 4.68 years) were included in this study. Significantly higher levels of behavior problems than in the general population and an increase in these problems, especially internalizing ones, over time could be found. In contrast, maternal stress did not change significantly over time, but mothers demonstrated increased levels of strain and reduced life satisfaction at T2. Thus, careful monitoring as well as early and adequate interventions, if indicated, should be offered to families with a child with 22q11.2DS, not only for somatic complaints but also for problems with psychological adjustment.

Mother-child interactions among children with visual impairment: Addressing maternal attachment style, depression-anxiety symptoms, and child's behavioral problems.

The birth of a visually impaired child leads to stress, disappointment, and medical challenges for the family due to the economic and financial costs, unmet expectations of other family members, and social embarrassment-isolation of the family from society. In these families, mothers are exposed to the stressors more often than other family members, because, in most families, they are the primary caregivers. In this study, we examined the relationship between maternal attachment styles, maternal depression and anxiety levels, and behavioral problems of children with visual impairment. This is a case-control study. In the study group, there were 35 children with visual impairment, and in the control group, there were 31 healthy children. All mothers completed adult attachment style dimensions scales, beck depression, and anxiety inventories, and the aberrant behaviour checklist. Our results demonstrated that children with visual impairment have higher levels of behavior problems including irritability, stereotypic behavior, and inappropriate speech when compared with healthy controls. Contrary to our expectations depression and anxiety, scores of mothers were similar, also, there was not a difference in terms of maternal attachment types. Interestingly, there was a positive relationship between secure attachment and depression among mothers of the visual impairment group. In other words, securely attached mothers were more depressive. On the other hand, there was a positive relationship between anxious/ambivalent attachment and the child's irritability. The relationship between maternal depression and secure attachment could be a consequence of higher maternal sensitivity due to a child's impairment and should be evaluated in future studies.

Behavioral Outcomes in Children With an Orofacial Cleft in a National Study in New Zealand.

To determine whether children with an orofacial cleft have higher levels of behavioral problems than the general population and whether this differs by cleft phenotype. A cohort of children with cleft lip and/or palate (CL/P) born in New Zealand from January 1, 2000. Cleft clinics in New Zealand participating in a larger outcomes study between 2014 and 2017. Children (N = 378) aged 5 to 12 years of age and their parents. The Strengths and Difficulties Questionnaire (SDQ) and Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales 4.0 and Family Impact Module 2.0. Compared to standardized norms, children with a cleft had higher than expected (defined as 20%) levels of abnormal/borderline SDQ scores for conduct problems (27.4%, P = .0003) and peer relationship problems (31.6%, P < .0001) but lower than expected levels of problems with pro-social skills (6.3%, P < .0001). There were no significant differences by age-group and or cleft phenotype other than an increased risk of hyperactivity in children with CP compared to children with CL. Total difficulties SDQ scores had moderate correlations with the PedsQL. While over 90% of children with CL/P had normal prosocial skills, they may not be easily accepted by their peers which may result in behavioral problems. These concerns were moderately related to lower quality of life. Support for establishment and maintenance of peer relationships is important to address externalizing and peer difficulties in children with CL/P. Community knowledge and understanding of CL/P needs to continue to be promoted.

Worldwide school-based psychosocial interventions and their effect on aggression among elementary school children: A systematic review 2010–2019

Abstract Aggression in childhood has been linked to adverse outcomes in later life, for both victims and perpetrators. School-based prevention programs have been previously shown to be at least somewhat effective in reducing child aggression. The aim of this review is to evaluate the most recent literature regarding school-based prevention programs reporting aggression-related outcomes among school children ages 6–11 worldwide. Three online databases (PubMed, Embase, and Scopus) were searched for relevant articles published between 2010 and 2019. Preliminary searches yielded 255 results; fifteen articles fully met inclusion criteria. Of the fifteen studies included, fourteen reported at least some positive effect on aggression through improvement in social and/or emotional competencies. One study reported both an iatrogenic and a positive effect and a single study reported no effect. Moderation and mediation analyses suggest prevention programs may be particularly effective among students with relatively low self-regulation and/or high levels of problem behavior at baseline. Despite the heterogeneity among interventions, findings add to the growing empirical evidence regarding the positive impact of school-based prevention programs that target social and emotional competencies on the reduction of aggressive behavior in children. Public health interventions should promote these evidence-based programs in order to reduce the burden caused by aggressive behaviors in childhood.

Indicators of Social Competence and Social Participation Among US Children With Tourette Syndrome.

Children with Tourette syndrome often have behavioral and social difficulties, which may be associated with co-occurring mental, emotional, or behavioral disorders. This study investigated social competence, including behavioral problems and social skills, and social activities between children with and without Tourette syndrome using a nationally representative sample. In the 2007 National Survey of Children's Health, parents reported on health care provider diagnosis of Tourette syndrome, co-occurring mental, emotional, or behavioral disorders, and indicators of social competence. Children aged 6-17 years with and without Tourette syndrome were compared. Most (78.7%) children with Tourette syndrome had a co-occurring mental, emotional, or behavioral disorder. Children with Tourette syndrome had significantly lower social competence, exhibited by higher levels of behavior problems (mean score 11.6 for Tourette syndrome and 9.0 for no Tourette syndrome) and lower levels of social skills (mean 15.3) than children without a Tourette syndrome diagnosis (mean 17.1); however, these associations were no longer significant after controlling for co-occurring mental, emotional, or behavioral disorders. Moderate to severe Tourette syndrome was associated with the highest ratings of behavioral problems and the lowest ratings of social skills. Children with and without Tourette syndrome were equally likely to participate in social activities; the difference for children with moderate to severe Tourette syndrome being less likely to participate in activities compared to children with mild Tourette syndrome had a chi-square test P value of .05. In conclusion, Tourette syndrome was associated with lower social competence, particularly for children with moderate to severe Tourette syndrome. Monitoring social functioning and co-occurring conditions among children with Tourette syndrome, and referral for evidence-based interventions when needed, may benefit overall health and functioning.

Association between maternal adverse childhood experiences and mental health problems in offspring: An intergenerational study.

The aim of this study is to examine the association between maternal adverse childhood experiences (ACEs) and mental health problems in adolescent offspring. Data were obtained from the population-based Kochi Child Health Impact of Living Difficulty (K-CHILD) study in 2016, and participants were 10,810 children in the fifth grade (3,144 pairs), eighth grade (3,497 pairs), and eleventh grade (4,169 pairs) living in Kochi Prefecture, Japan. Mothers of participating children were asked about their ACEs, childhood social economic status, current mental and physical health, current social economic status, positive parenting behaviors, child maltreatment, marital status, and child behavior problems using the Strength and Difficulty Questionnaire. Children reported their depressive symptoms using the Depression Self-Rating Scale. Children of mothers with a larger number of ACEs showed higher levels of behavior problems (p for trend <.001) and depressive symptoms (p for trend <.001), adjusting for potential confounders. In particular, maternal psychological distress mediated the association between maternal ACEs and child mental health. The adverse effects of maternal ACEs may have a direct intergenerational impact on behavior problems and depressive symptoms in adolescent offspring. Further studies to elucidate possible mediators are needed.

Adolescent and young adult mental health problems and infant offspring behavior: Findings from a prospective intergenerational cohort study

BackgroundParental depression and anxiety have been consistently linked to offspring behavior problems across childhood. However, many of the risks for these common mental health problems are established well before pregnancy. This study takes advantage of rare, prospective data to examine relations between parental mental health histories (from adolescence onwards) and next generation offspring behavior problems. MethodsData were drawn from a multi-generational cohort study that has followed Australians from infancy to adulthood since 1983, and 1171 of their offspring assessed prospectively from pregnancy. Generalized estimating equation models were used to estimate associations between parents’ depression/anxiety symptoms in adolescence and young adulthood and offspring behavior problems at 1 year. ResultsIn analyses of 648 mother-infant and 423 father-infant dyads, after adjustment for confounders and concurrent mental health problems, mean behavior problem scores in infants of mothers with a history of mental health problems in both adolescence and young adulthood were over half a standard deviation higher than those of mothers without problems during these periods, B = 2.19, 95% CI 1.21 – 3.17, β = 0.52. No association was observed for fathers. LimitationsWe only included infants born to participants aged 29–35 years and we assessed behavior problems via parent-report. ConclusionsA mother's history of persistent depression and anxiety from adolescence to young adulthood can predict higher levels of behavior problems in her infant. Findings support calls for greater policy and prevention focus on preconception and postnatal mental health, particularly a mother's early emotional health history, prior to parenthood.

Parenting Style, Child Emotion Regulation and Behavioral Problems: The Moderating Role of Cultural Values in Australia and Indonesia

Research has shown that the congruence of parenting styles with cultural values, rather than parenting styles alone, impacts child adjustment. This study examined if parents’ cultural values moderate the relationships between parenting styles and child outcomes across both an individualist culture (Australia) and a collectivist culture (Indonesia). Three hundred and eighty-seven parents of 2–10-year-old children from both countries reported their parenting styles, the importance of the collectivistic values (security, conformity, and tradition), and their child's emotion regulation and behavioral problems. In both countries, authoritative parenting was associated with higher child emotion regulation and lower levels of behavioral problems, and authoritarian parenting was associated with lower child emotion regulation and higher levels of behavioral problems. Although cultural values did not moderate the relationship between authoritarian parenting and child adjustment, in both countries greater importance placed on tradition attenuated the positive effect of authoritative parenting on child outcomes.

Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5years rated by parents and preschool teachers.

The Strengths and Difficulties Questionnaire (SDQ) is a widespread tool for assessing behavior problems in children and adolescents. Despite being investigated thoroughly concerning both validity and reliability, peer reviewed studies that provide norms, especially for preschool children, are lacking. This paper provides Swedish norms using data from a large community sample of children aged 3–5, based on mothers’, fathers’, and preschool teacher’s ratings. Preschool teachers’ ratings were generally lower than parents’ ratings, which contradicts some previous studies. Differences between girls and boys were found, suggesting that boys display higher levels of behavior problems. Lower parental education and country of origin outside of Sweden were also associated with more difficulties. Cut‐offs are presented for each age group, gender and rater category. Population‐specific norms and percentile cut‐offs provided in this study facilitate identifying children in need of interventions in paediatric care and enable cross‐country comparisons of children’s mental health problems.