Rates Of Behavior Problems Research Articles

Getting Started - Getting Better

An introduction: (comprising context and problem statement) Midland Area Parenting Partnership (MAPP) Triple P initiative is the first population-based intervention in Ireland to demonstrate that a parenting programme significantly impacted on prevalence of children’s socio-emotional and behavioural problems. Short description of practice change implemented: Effectiveness relates to integration of Triple P Positive Parenting Programme evidence, local implementation plan and the enabling environment. These 3 elements benefited from planned and systematic practice change. Aim and theory of change: The aims of this initiative were to determine whether a reduction could be achieved in the prevalence rate of children showing socio-emotional and behavioural problems and to develop an implementation guide. The theory of change, hypothesised that the combination of inputs (access to communication approaches, evidence based programme, high quality training accreditation and mentoring for practitioners, internal and external partnerships and resources) and effective implementation would achieve wide ranging gains for children and parents within the population. Targeted population and stakeholders: The target population was parents of children aged 3-7. The MAPP partnership comprised statutory, voluntary and community sector organisations Timeline: The evaluation was completed over a 2.5 year. The Implementation Guide was developed upon this experience and the expansion into 2 new counties. Highlights: (innovation, Impact and outcomes) Innovation in the present study included the use of a locally developed implementation framework and a core team consisting of multidisciplinary staff from partner organisations who reoriented their work. The evaluation showed a significant reduction in the prevalence rates of socio-emotional and behavioural problems over time. A guide was developed to facilitate the intentional, explicit and systematic implementation of the MAPP approach in other areas. Comments on sustainability: The elements of this model which promote sustainability are: The use of a core delivery team. Routine focus on the enabling environment & Routine gathering and use of implementation and outcome data. Comments on transferability: The local evidence of effectiveness combined with the implementation guide support transferability, in addition the outcomes need to be sufficiently valued by local parents and partner organisations. MAPP has expanded into 4 counties and delivers to parents with children 15 years of age and younger. Conclusions: (comprising key findings) This work demonstrated that a partnership approach to universal parenting when implemented well can result in significant reduction in prevalence rates for socio-emotional and behavioural problems. Discussions: The relationship between the evidence-based programme, implementation plan and enabling environment are the active ingredients needed to achieve better outcomes. The implementation structure was a key determinant in achieving the positive results for partners, practitioners and families, and the partnership was key to establishing and maintaining the enabling environment Lessons learned: The partnership fostered the enabling environment and the core team becomes the key driver for the implementation. A key element for the successful integrated planning was the devolving of authority to the core team for developing and progressing the implementation. A strong focus on implementation contributed to the population effect.

Emotional and Behavioral Health Needs in Elementary School Students in an Underserved Hispanic Community.

High rates of mental health problems in adolescents have been well documented; less is known about elementary school children in disadvantaged communities. We examined emotional and behavioral health needs in 202 third and fourth graders enrolled in a charter school in a largely Hispanic community. The child-reported Revised Child Anxiety and Depression Scale-25 and Teacher's Report Form were used to evaluate mental health needs as perceived by these children and their teachers. The prevalence of teacher-reported depression and child self-reported anxiety was 7.0% and 6.67%, respectively. Living in a single parent household was found to be a specific risk factor in that those children had higher rates of emotional and behavioral problems than children living with both parents. Evidence of higher depression and anxiety identified in this sample compared to national representative data suggests the need for development of culturally sensitive early prevention and intervention in this underserved community.

Emotional and behavioural problems in children with Developmental Coordination Disorder: Exploring parent and teacher reports

BackgroundAlthough characterised by motor impairments, children with Developmental Coordination Disorder (DCD) also show high rates of psychopathology (anxiety, depression, low self-esteem). Such findings have led to calls for the screening of mental health problems in this group. AimsTo investigate patterns and profiles of emotional and behavioural problems in children with and without DCD, using the Strengths and Difficulties Questionnaire (SDQ). Methods and proceduresTeachers and parents completed SDQs for 30 children with DCD (7–10 years). Teacher ratings on the SDQ were also obtained from two typically-developing (TD) groups: 35 children matched for chronological age, and 29 younger children (4–7 years) matched by motor ability. Outcomes and resultsGroup and individual analyses compared parent and teacher SDQ scores for children with DCD. Teacher reports showed that children with DCD displayed higher rates of emotional and behavioural problems (overall, and on each subscale of the SDQ) relative to their TD peers. No differences were observed between the two TD groups. Inspection of individual data points highlighted variability in the SDQ scores of the DCD group (across both teacher and parent ratings), with suggestions of elevated hyperactivity but comparably lower levels of conduct problems across this sample. Modest agreement was found between teacher and parent ratings of children with DCD on the SDQ. Conclusions and implicationsThere is a need to monitor levels of emotional and behavioural problems in children with DCD, from multiple informants.

Behavioral Risk Assessment From Newborn to Preschool: The Value of Older Siblings.

The aim of this study was to examine the plausibility of a risk prediction tool in infancy for school-entry emotional and behavioral problems. Familial aggregation has been operationalized previously as maternal psychopathology. The hypothesis was tested that older sibling (OS) psychopathology, as an indicator of familial aggregation, would enable a fair level of risk prediction compared with previous research, when combined with traditional risk factors. By using a longitudinal design, data on child and family risk factors were collected on 323 infants (M = 2.00 months), all of whom had OSs. Infants were followed up 4.5 years later when both parents provided ratings of emotional and behavioral problems. Multiple regression and receiver operating characteristic curve analyses were conducted for emotional, conduct, and attention problems separately. The emotional and behavioral problems of OSs at infancy were the strongest predictors of the same problems in target children 4.5 years later. Other risk factors, including maternal depression and socioeconomic status provided extra, but weak, significant prediction. The area under the receiver operating characteristic curve for emotional and conduct problems yielded a fair prediction. This study is the first to offer a fair degree of prediction from risk factors at birth to school-entry emotional and behavioral problems. This degree of prediction was achieved with the inclusion of the emotional and behavioral problems of OSs (thus limiting generalizability to children with OSs). The inclusion of OS psychopathology raises risk prediction to a fair level.

The Relationship between Personality Traits and Behavioral Problems among Adolescents in Malaysia

The increased rates of behavioral problems among adolescents are alarming in Malaysia. Previous studies indicated that individuals’ personality traits may contribute to the engagement of behavioral problems among adolescents. However, there are still limited published researches in Malaysia context. Thus, this study aimed to investigate the effect of personality traits on internalizing and externalizing behavioral problems among adolescents in Malaysia. There were 480 school-going adolescents aged between 13 to 17 years old, recruited by using multistage cluster sampling method from Selangor, Perak and Kedah states of Malaysia. Two instruments used in this study were Big Five Inventory (BFI), and Strength and Difficulties Questionnaire (SDQ). The results of the study showed that the higher the level of openness, conscientiousness, extraversion and agreeableness and the lower the level of neuroticism were linked to the low tendency in the engagement of internalizing and externalizing behavioral problems among adolescents in Malaysia. Regression analyses indicated that personality traits of neuroticism appeared to be the strongest predictor for both adolescents’ internalizing and externalizing behavioral problems. Findings of the study stressed the importance of understanding adolescents’ personality traits when studying on adolescents’ internalizing and externalizing behavioral problems. Hence, the provision of social skills and coping strategies among adolescents are necessary to promote better human development.

Attachment representations and socio-emotional difficulties in alternative care: A comparison between residential, foster and family based children in Chile

Attachment has been assessed in children living in alternative care (AC) settings, such as Residential Homes (RC) and Foster Care (FC). However, no study has been conducted to compare attachment styles in residential, foster and parental care conducted as usual in the same country at the same point in time. There is also a lack of studies conducted in less developed countries. Therefore, the aim of this study was to compare outcomes for children living in three different types of care in Chile. Three groups of children (N=77), living in (RC), (FC) and with biological parents (PC) were compared. Attachment styles, Indiscriminate Friendliness (IF) and socio-emotional/behavioral difficulties were assessed.Higher rates of secure attachment were observed in the RC group (36.1%) when compared to studies in RC in other countries (mean 18%). However, children in both types of AC were significantly more likely to have insecure and/or disorganized attachment styles than PC children. Higher rates of socio-emotional and behavioral problems were observed in RC (55.6%) and FC (50%) compared to PC (10%). Within type of AC, no significant differences were found, for attachment styles or for socio-emotional/behavioral difficulties, the only difference were the levels of IF, with children in RC having higher levels. As a conclusion, impact of placement in AC can vary between different countries, other factors, rather than only type of AC could better explain differences in attachment security for children. Implications for research and practices are discussed.

Avaliação e tratamento de comportamentos problemas de duas pessoas com o diagnóstico de depressão

Este estudo envolveu a avaliação e tratamento de comportamentos-problema de duas pessoas com o diagnóstico de depressão em que eventos motivadores antecedentes e reforçadores consequentes para os comportamentos-problema consistiram em atenção social e fuga de demandas. As participantes eram do sexo feminino e relataram ter recebido esse diagnóstico desde a adolescência. Para avaliar os relatos de comportamentos-problema, foram empregadas estratégias de avaliação funcional por observação indireta, por observação direta e a análise funcional com quatro condições principais: atenção, fuga de demanda, sozinho e controle. As participantes exibiram altos índices de comportamentos-problema nas condições de atenção e fuga de demandas, o que evidencia o controle do responder pelos eventos motivadores antecedentes e pelos reforços consequentes. Na condição de controle foi possível observar a eficácia da densidade de reforçadores, e na condição sozinho os comportamentos-problema não ocorreram. Para tratar os relatos de comportamentos-problema, o programa de intervenção incluiu o reforço diferencial (DRA), mais a extinção (EXT), com uso do delineamento de reversão-replicação seguido por follow-up. Observou-se que o uso do DRA mais EXT diminuiu os relatos de comportamentos-problema e aumentou os relatos de comportamentos desejados de forma confiável.

A comparison of existing and novel communication responses used during functional communication training

Functional communication training (FCT) is a procedure used to teach a communicative response that results in the same reinforcer found to maintain problem behavior. Previous research has demonstrated that high levels of problem behavior may be observed during FCT when reinforcing an existing response due to a history of reinforcement for both existing responses and problem behavior. This study compared the effects of reinforcing an existing and novel communicative response during FCT on the rate of problem behavior for two children diagnosed with autism. Additionally, we assessed preference for either the existing or novel response using a concurrent schedules arrangement. The results demonstrated that the existing and novel communication responses were associated with low levels of problem behavior for both participants. Also, both participants preferred the novel response. We conclude with a discussion of practical applications of the analysis and avenues for future research.

Prevalence and Factors Associated With Criminal Behavior Among Illicit Drug Users: A Cross-Sectional Study

ABSTRACTBackground: Studies indicate high rates of criminal behavior, violent activities, and legal problems among illicit drug users (IDU) in Brazil. The aim of this study was to estimate the prevalence and factors associated with criminal behavior among IDU undergoing treatment for chemical dependency in Central Brazil. Methods: Cross-sectional study carried out with IDU undergoing treatment for chemical dependence. Data were collected by means of face-to-face interviews and analyzed using logistic regression. Results: Of the total participants (n = 274), 46.7%, 15.7%, and 10.9% reported involvement in robbery, drug trafficking and homicide, respectively. Robbery was associated with young age, withdrawal symptoms, prison record, sex work, and crack use, while drug trafficking was associated with young age, low education, and marijuana use. Homicides were associated with cocaine and marijuana use. Conclusion: The results show high rates of criminal behavior among drug users, demonstrating associations between socio-demographic and behavioral characteristics, illicit drug use, and practices of illegal activities. These variables must be considered when planning programs and policies to reduce harm related to drug use and abuse.

Preference Assessment for Dimensions of Reinforcement to Inform Token Economies Targeting Problem Behavior

The purpose of the current two-experiment study was to examine the use of a preference assessment for dimensions of reinforcement to inform an effective token economy arrangement. Three participants diagnosed with developmental disabilities who engaged in negatively reinforced problem behavior participated in this study. During Experiment 1, a preference assessment for four dimensions of reinforcement (i.e., quality, immediacy, magnitude, and rate) occurred to inform a more- and less-preferred token economy arrangement. During Experiment 2, a treatment evaluation compared these two token economy arrangements. Results for all three participants showed lower rates of problem behavior under the more-preferred token economy arrangement compared to the less-preferred token economy arrangement. Rates of task completion were higher under the more-preferred token economy arrangement for one of the three participants. Results are discussed in terms of their practical implications for clinicians and educators implementing token economies to manage problem behavior.

A “Healthy-Contingencies” Behavioral Intervention

Interventions based on functional analyses may result in better treatment outcomes than those using arbitrary reinforcers. However, functional analyses may be impractical in some situations, or an immediate intervention may be necessary while a functional analysis is being conducted. In these situations, delivering the social reinforcers most commonly identified by functional analyses (attention, access to tangibles, and escape from demands) following appropriate behavior and withholding these events following problem behavior may improve behavior. We assessed the extent to which this type of intervention would improve child behavior with three participants. All participants engaged in moderate to high rates of problem behavior and very little appropriate requesting during baseline, and high rates of appropriate requests and reduced rates of problem behavior during treatment.

Being Poorer Than the Rest of the Neighborhood: Relative Deprivation and Problem Behavior of Youth

According to the neighborhood effects hypothesis, there is a negative relation between neighborhood wealth and youth’s problem behavior. It is often assumed that there are more problems in deprived neighborhoods, but there are also reports of higher rates of behavioral problems in more affluent neighborhoods. Much of this literature does not take into account relative wealth. Our central question was whether the economic position of adolescents’ families, relative to the neighborhood in which they lived, was related to adolescents’ internalizing and externalizing problem behavior. We used longitudinal data for youth between 12–16 and 16–20 years of age, combined with population register data (N = 926; 55% females). We employ between-within models to account for time-invariant confounders, including parental background characteristics. Our findings show that, for adolescents, moving to a more affluent neighborhood was related to increased levels of depression, social phobia, aggression, and conflict with fathers and mothers. This could be indirect evidence for the relative deprivation mechanism, but we could not confirm this, and we did not find any gender differences. The results do suggest that future research should further investigate the role of individuals’ relative position in their neighborhood in order not to overgeneralize neighborhood effects and to find out for whom neighborhoods matter.

An individualized method for establishing and thinning multiple schedules of reinforcement following functional communication training

Using multiple schedules of reinforcement following functional communication training (FCT) can produce discriminated mands while maintaining low rates of problem behavior (Fisher et al., 1998; Hanley et al., 2001). A review of this literature (Saini et al., 2016) noted the absence of a method for systematically determining the duration of reinforcement (SD) and extinction (SΔ) components in such multiple-schedule arrangements. The same review also suggested that introducing a momentary differential-reinforcement contingency could aid in producing discriminated mands by eliminating the possibility of adventitious reinforcement. The current investigation attempted to evaluate these two recommendations by altering the durations of SD and SΔ components of a multiple schedule based on participants’ response patterns during treatment. Specifically, we (a) yoked the duration of the initial SΔ component to the rate of mands during FCT and (b) introduced a delay to the SD following instances of problem behavior. All five participants exhibited discriminated mands. In addition, mands maintained for all five participants, and problem behavior remained low for four participants when the schedule of reinforcement was systematically thinned.

Earlier school start times are associated with higher rates of behavioral problems in elementary schools

BackgroundEarly school start times may curtail children's sleep and inadvertently promote sleep restriction. The current study examines the potential implications for early school start times for behavioral problems in public elementary schools (student ages 5-12 years) in Kentucky. MethodSchool start times were obtained from school Web sites or by calling school offices; behavioral and disciplinary problems, along with demographic information about schools, were obtained from the Kentucky Department of Education. Estimated associations controlled for teacher/student ratio, racial composition, school rank, enrollment, and Appalachian location. ResultsAssociations between early school start time and greater behavioral problems (harassment, in-school removals, suspensions, and expulsions) were observed, although some of these associations were found only for schools serving the non-Appalachian region. ConclusionsFindings support the growing body of research showing that early school start times may contribute to student problems, and extend this research through a large-scale examination of elementary schools, behavioral outcomes, and potential moderators of risk.

The Child Behavior Checklist-Obsessive-Compulsive Subscale Detects Severe Psychopathology and Behavioral Problems Among School-Aged Children.

The aims of this study were (1) to assess obsessive-compulsive symptoms (OCS) dimensionally in a school-aged community sample and to correlate them with clinical and demographical variables; (2) to determine a subgroup with significant OCS ("at-risk for OCD") using the Child Behavior Checklist (CBCL-OCS) and (3) to compare it with the rest of the sample; (4) To review the CBCL-OCS subscale properties as a screening tool for pediatric OCD. Data from the Brazilian High Risk Cohort were analyzed. The presence and severity of OCS were assessed through the CBCL-OCS subscale. DSM-IV psychiatric diagnoses were obtained by the Developmental and Well-Being Assessment. Behavioral problems were assessed using the Strengths and Difficulties Questionnaire, the Youth Strengths Inventory, and the CBCL internalizing and externalizing behavior subscales. A total of 2512 (mean age: 8.86 ± 1.84 years; 55.0% male) children were included. Moderate correlations were found between OCS severity and functional impairment (r = 0.36, p < 0.001). Children with higher levels of OCS had higher rates of psychiatric comorbidity and behavioral problems (p < 0.001). A score of 5 or higher in the CBCL-OCS scale determined an "at-risk for OCD" subgroup, comprising 9.7% of the sample (n = 244), with behavioral patterns and psychiatric comorbidities (e.g., tics [odds ratios, OR = 6.41, p < 0.001]), anxiety disorders grouped [OR = 3.68, p < 0.001] and depressive disorders [OR = 3.0, p < 0.001] very similar to those described in OCD. Sensitivity, specificity, positive predictive value, and negative predictive value of the CBCL-OCS for OCD diagnosis were, respectively, 48%, 91.5%; 15.1%, and 98.2%. The dimensional approach suggests that the presence of OCS in children is associated with higher rates of comorbidity, behavioral problems, and impairment. The "at-risk for OCD" group defined by the CBCL revealed a group of patients phenotypically similar to full blown OCD.

The Treatment of Severe Childhood Aggression Study: 12 Weeks of Extended, Blinded Treatment in Clinical Responders.

Previous "Treatment of Severe Childhood Aggression" (TOSCA) reports demonstrated that many children with severe physical aggression and attention-deficit/hyperactivity disorder (ADHD) responded well to two randomized treatments (parent training [PT]+stimulant+placebo = Basic vs. PT+stimulant+risperidone = Augmented) for 9 weeks. An important clinical question is whether these favorable outcomes are maintained over longer times. Clinical responders to the 9-week trial (n = 103/168), defined as Clinical Global Impressions (CGI)-Improvement of much/very much improved plus substantial reduction in parent ratings of disruptiveness, were followed another 12 weeks (21 weeks total) while remaining on blinded treatment. Outcome measures included Clinical Global Impressions scale, Nisonger Child Behavior Rating Form (NCBRF), other parent/teacher-rated scales, laboratory tests, clinician ratings of abnormal movement, and other adverse events (AEs). Parent ratings of problem behavior showed minimal worsening of behavior from end of the 9-week acute trial (expected from regression to the mean after selecting best responders), but outcomes at Extension endpoint were meaningfully improved compared with acute study baseline. As expected, outcomes for Basic and Augmented treatment did not differ among these children selected for good clinical response. During Extension, more Augmented subjects had elevated prolactin; there were no clinically confirmed cases of tardive dyskinesia. Delayed sleep onset was the most frequent Basic AE. We also conducted a last-observation-carried-forward analysis, which included both nonresponders and responders. We found that, at the end of Extension, Augmented subjects had more improvement than Basic subjects on the NCBRF Positive Social subscale (p = 0.005; d = 0.44), the Antisocial Behavior Scale Reactive Aggression subscale (p = 0.03; d = 0.36), and marginally so on the Disruptive Behavior Total subscale (p = 0.058; d = 0.29, the primary outcome). The medium-term outcomes were good for the participants in both treatment groups, perhaps because they were selected for good response. When nonresponders were included in ITT analyses, there was some indication that Augmented surpassed Basic treatment.

Intellectual Disability and Developmental Risk: Promoting Intervention to Improve Child and Family Well-Being.

Initial intervention processes for children with intellectual disabilities (IDs) largely focused on direct efforts to impact core cognitive and academic deficits associated with the diagnosis. Recent research on risk processes in families of children with ID, however, has influenced new developmental system approaches to early intervention. Recent risk and resilience processes are reviewed that connect stress, family process, and the high rates of behavioral problems in children with ID that have substantial influence on child and family outcomes. These models are linked to emerging evidence-based intervention processes that focus on strategic parent skill training and mindfulness interventions that reduce parental stress and create indirect benefits for children's behavioral competencies. A family-focused developmental systems approach (M. J. Guralnick, 2011) is emphasized.

Alcohol Consumption among Female University Students in Israel: a Cross Sectional Study of Background Characteristics and Drinking Patterns

This cross sectional study examined alcohol use, binge drinking and other problem behavior among Israeli university female students. Scant information is known about Israeli university student alcohol use and related problem behavior. Academic study discipline status (e.g., social work, nursing and other non-helping disciplines) was hypothesized to be a predictor of university student alcohol use and problem behavior rates. Study hypotheses were supported, in part. Academic discipline (social work and nursing) differentiated rates of alcohol use, binge drinking and other problem behavior. However, when grouped into helping and non-helping academic disciples, few differences were evidenced. Students drink more beer, wine and hard alcohol than those 20 years ago at the same university; however, fewer students drive after drinking. Present results, albeit restricted, reflect increased drinking but less driving after drinking after an intensive campaign to curb such problem behavior. Further research is needed of alcohol use and problem behavior for policy, prevention and treatment purposes. Such research should include regular monitoring throughout the country regardless of gender status and academic discipline.

Social Functioning and Behaviour in Mucopolysaccharidosis IH [Hurlers Syndrome

Mucopolysaccharidosis type IH (MPS-IH) [Hurlers Syndrome] is a developmental genetic disorder characterised by severe physical symptoms and cognitive decline. This study aimed to investigate the behavioural phenotype of MPS-IH treated by haematopoietic cell transplantation, focusing on social functioning and sleep. Parental stress was also measured. Participants were 22 children with MPS-IH (mean age 9years 1 month), of whom 10 were male (45%). Parents completed the Social Responsiveness Scale (SRS), Child Behaviour Checklist (CBCL), Children's Sleep Habit Questionnaire and Parent Stress Index, Short Form (PSI-SF). Twenty-three per cent of children with MPS-IH scored in the severe range of the SRS, suggesting significant difficulties in social functioning. Children with MPS-IH were more than 30 times more likely to receive scores in the severe range than typically developing children. Thirty-six per cent scored in the mild-to-moderate range, suggesting milder, but marked, difficulties in social interaction. Although children with MPS-IH did not show significantly higher rates of internalising, externalising or total behaviour problems than the normative sample, they received scores that were significantly higher on social, thought and attention problems and rule-breaking behaviour, and all the competence areas of the CBCL. Parents of children with MPS-IH did not score significantly higher on parental stress than parents in a normative sample. Parents of children with MPS-IH rate their children as having problems with social functioning and various areas of competence more frequently than previously thought, with implications for clinical support.

Evaluating Treatments for Functionally Equivalent Problem Behavior Maintained by Adult Compliance with Mands During Interactive Play

A primary goal of behavioral interventions is to reduce dangerous or inappropriate behavior and to generalize treatment effects across various settings. However, there is a lack of research evaluating generalization of treatment effects while individuals with functionally equivalent problem behavior interact with each other. For the current study, the severe problem behavior of two participants with developmental disabilities was targeted for assessment and treatment. Results of a functional analysis indicated that for both participants, problem behaviors occurred when destructive behavior produced reinforcement of participant mands . The use of a multiple schedule that alternated between differential reinforcement of other behaviors and differential reinforcement of alternative behavior (mands) was sufficient to produce a significant reduction in problem behavior for one participant; the addition of differential reinforcement of alternative behaviors via compliance was necessary for the second participant. Extended treatment sessions, which focused on interaction between the two participants, involved one therapist concurrently implementing each participant’s treatment while they were directed to play with one another (a situation that previously evoked problem behavior). Results show that each participant’s treatment produced low to zero rates of problem behavior even during extended interactions.