Rates Of Behavior Problems Research Articles

1257 The Neurodevelopmental Assessment of Very Low Birth Weight Infants at 4–6 Years of Age

The major and minor neurodevelopmental morbidities among premature infants become an important issue because of the increase in the number of surviving premature newborns.The Aim of this study was to...

How Does the Inclusion of Twins Conceived via Fertility Treatments Influence the Results of Twin Studies?

Rates of twinning have risen dramatically over the last 30 years, from 1 in 53 births in 1980 to 1 in 30 births in 2009 (Martin et al. (January 2012). Three decades of twin births in the United States, 1980-2009. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics). This increase is largely attributable to increases in the use of fertility treatments (i.e., ovulation induction and in vitro fertilization) combined with delays in parenthood. Although this increase means that more twins are available for recruitment into twin studies, it also has potential consequences for the heritability estimates obtained in these studies. This study sought to evaluate this possibility, making use of the ongoing Michigan Twins Project (N = 7,261 families with twins aged 3-17 years), an arm of the Michigan State University Twin Registry. Results revealed that, on average, twins conceived via fertility treatments had lower rates of behavior problems than those conceived naturally, although these behavioral differences could be explained largely by demographic and socio-economic differences across the two types of twin families. Twin similarity did not meaningfully differ across fertility treatment status. We thus conclude that estimates of genetic and environmental influences obtained from twin studies over the last 10-15 years are more or less unaffected by the inclusion of twins conceived via fertility treatments in their samples.

Persistent Snoring in Preschool Children: Predictors and Behavioral and Developmental Correlates

To clarify whether persistent snoring in 2- to 3-year-olds is associated with behavioral and cognitive development, and to identify predictors of transient and persistent snoring. Two hundred forty-nine mother/child pairs participated in a prospective birth cohort study. Based upon parental report of loud snoring ≥ 2 times weekly at 2 and 3 years of age, children were designated as nonsnorers, transient snorers (snored at 2 or 3 years of age, but not both), or persistent snorers (snored at both ages). We compared groups by using validated measures of behavioral and cognitive functioning. Potential predictors of snoring included child race and gender, socioeconomic status (parent education and income), birth weight, prenatal tobacco exposure (maternal serum cotinine), childhood tobacco exposure (serum cotinine), history and duration of breast milk feeding, and body mass relative to norms. In multivariable analyses, persistent snorers had significantly higher reported overall behavior problems, particularly hyperactivity, depression, and inattention. Nonsnorers had significantly stronger cognitive development than transient and persistent snorers in unadjusted analyses, but not after demographic adjustment. The strongest predictors of the presence and persistence of snoring were lower socioeconomic status and the absence or shorter duration of breast milk feeding. Secondary analyses suggested that race may modify the association of childhood tobacco smoke exposure and snoring. Persistent, loud snoring was associated with higher rates of problem behaviors. These results support routine screening and tracking of snoring, especially in children from low socioeconomic backgrounds; referral for follow-up care of persistent snoring in young children; and encouragement and facilitation of infant breastfeeding.

Parent attachment, school commitment, and problem behavior trajectories of diverse adolescents

The purpose of this study was to examine the growth trajectories from early to late adolescence of teacher ratings of students' behavior problems from 9th through 11th grade and student self-reports of alcohol use in a sample of predominately minority adolescents (n = 179, 90% African-American and/or Hispanic, 43% boys, 57% girls) in a large, urban school district. The study investigated whether parent attachment, school commitment, gender, race/ethnicity, and educational placement influenced these outcomes. Multi-level growth modeling was the primary statistical procedure used. Results indicated that increased parent attachment was associated with reduced levels of alcohol use and school commitment was not associated with growth trajectories of problem behavior in the multilevel models, although gender, race/ethnicity and special education placement were significant predictors. Our findings suggest that teachers perceive greater levels of behavior problems for minority students and youth in special education. Student self reports also indicate adolescent frequency of alcohol use increases over time.

A cross-cultural comparison of teacher ratings of child adjustment and behavioral problems

This study examines similarities and differences in teacher ratings of behavioral problems and adaptive skills between a sample of 320 students from Anguilla, BWI and 315 children from the United States of America using the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992 ). The study also compared teacher ratings of boys and girls in the Caribbean sample. Analyses of variance (ANOVA) revealed that Anguillian teachers rated their students as having higher mean school problems, while the mean score for adaptive skills was higher for US students. Effect sizes were small, though, indicating that little of the variance in ratings was attributable to cultural group. Boys in the Caribbean sample had significantly higher mean scores on externalizing and school problems. Girls were rated at having more adaptive skills. Again, effect sizes for the differences were small. Scientific and practice implications are offered.

The Aftercare and School Observation System (ASOS): Reliability and Component Structure

This study examines the psychometric properties and component structure of a newly developed observational system, the Aftercare and School Observation System (ASOS). Participants included 468 children drawn from a larger longitudinal intervention study. The system was utilized to assess participant children in school lunchrooms and recess and various afterschool environments. Exploratory factor analyses examined whether a core set of component constructs assessing qualities of children's relationships, caregiver involvement and monitoring, and experiences in school and aftercare contexts that have been linked to children's behavior problems would emerge. Construct validity was assessed by examining associations between ASOS constructs and questionnaire measures assessing children's behavior problems and relationship qualities in school and aftercare settings. Across both settings, two factors showed very similar empirical structures and item loadings, reflecting the constructs of a negative/aggressive context and caregiver positive involvement, with one additional unique factor from the school setting reflecting the extent to which caregiver methods used resulted in less negative behavior and two additional unique factors from the aftercare setting reflecting positivity in the child's interactions and general environment and negativity in the child's interactions and setting. Modest correlations between ASOS factors and aftercare provider and teacher ratings of behavior problems, adult-child relationships, and a rating of school climate contributed to our interpretation that the ASOS scores capture meaningful features of children's experiences in these settings. This study represents the first step of establishing that the ASOS reliably and validly captures risk and protective relationships and experiences in extra-familial settings.

Reducing Psychotropic Medications in an Intensive Residential Treatment Center

Medication rates in behaviorally disordered children and youth have greatly increased to current high levels and are very controversial. This study examined changes in psychotropic medication use, levels of behavioral disturbance, and use of personal restraint and seclusion in a population of youth with serious behavioral disorders receiving medically directed cognitive-behavioral treatment in an intensive residential setting. The hypothesis was that there would be significant reductions in medication rates, without the unintended consequences of increased rates of problem behavior or offsetting increases in the use of seclusion or personal restraint. Results showed significant reductions in both the number of youth on medication and the average number of psychotropic medications during the residential stay. There were also significant reductions in behavioral disturbance, seclusions, and personal restraints. These results demonstrate that psychotropic medication can be significantly reduced without increases in problem behavior or the use of seclusions or personal restraints. We conclude that it is possible to significantly reduce psychotropic medication rates to far more conservative levels within the context of a clinically directed cognitive-behavioral treatment milieu.

The Role of Parenting Stress in Discrepancies Between Parent and Teacher Ratings of Behavior Problems in Young Children with Autism Spectrum Disorder

The study assessed whether teacher and parent ratings of child behavior problems were similar for children with autism spectrum disorders. Two informants rated child behaviors in the same home environment, and the degree to which parenting stress impacted the similarity of the ratings was assessed. Overall behavior problem ratings did not differ between groups, but there was poor correspondence between the ratings for individual children, stress did not impact markedly on the discrepancies. Parent-teacher discrepancies in behavior ratings cannot be attributed entirely to differences in the assessment-environment, and there was little evidence of widespread impacts of parenting stress on these discrepant ratings. It was suggested that attention is needed in terms of the teacher characteristics when explaining such results.

The effects of conducting a functional analysis on problem behavior in other settings

It has been suggested that reinforcing problem behavior during functional analyses (FAs) may be unethical (e.g., Carr, 1977), the implication being that doing so may result in an increase in problem behavior outside of FA sessions. The current study assessed whether conducting a FA resulted in increases in problem behavior outside of the FA setting for 4 participants. The rate of problem behavior was measured outside the FA setting prior to and during a FA. Idiosyncratic results suggest that problem behavior outside of the FA setting may increase, decrease, or be unaffected by conducting a FA.

부부갈등과 어머니의 분노 및 우울이 유아의 행동문제에 미치는 영향

This study examined the effects of marital conflict and mothers` anger and depression on the behavioral problems of preschoolers. A total of 393 mothers with 3-year-old preschoolers responded to questionnaires, which included items related to marital conflict, mothers` anger and depression, and their preschoolers` behavioral problems. Data were analyzed by means of structural equation modeling. The results indicated that marital conflict had no direct effect, but there were indirect effects on preschoolers` behavioral problems caused by mothers` anger and depression. Mothers who believed that they were experiencing high levels of marital conflict revealed high levels of anger and depression and reported higher rates of behavioral problems in their children. Mothers` depression also mediated the impact of marital conflict on preschoolers` behavioral problems, but mothers` anger level apparently did not. The effects of mothers` level of depression on preschoolers` behavioral problems were the highest among all the predictors. These findings imply that both improving marital relationships and regulating mothers` anger and depression levels need to be emphasized when designing prevention and intervention programs aimed at improving the behavioral problems of preschoolers.

Stress and Coping in Parents of Children and Adolescents with Spinal Muscular Atrophy

Chronic illness and disability is not only associated with higher rates of behavioural problems in children, but also parental stress which requires active coping. The aim of the study was to analyse stress and coping, as well as their mediating variables, in parents of children and adolescents with Spinal Muscular Atrophy (SMA). 96 children and adolescents with SMA aged 6;0 to 18;11 years were compared to 59 age, sex and SES matched controls. Parental stress was measured with the QRS, coping with the F-COPES and social support with the F-SOZU questionnaires.Parental stress was significantly higher in the SMA families for the total score and all subscales of the QRS. Stress was higher in families with severely affected SMA types I and II. The greatest percentage of variance contributing to stress could be explained by lack of social support, degree of disability and behavioural problems in the child. Although social support was reduced, the actual coping abilities of the families did not differ. Families with children and adolescents with SMA show high degrees of stress and strain which are associated with the severity of the disease, reduced social support and child behaviour. Despite these stresses they manage and cope no differently from families with healthy children.

Agreement in multi-informant assessment of behaviour and emotional problems and social functioning in adolescents with Autistic and Asperger's Disorder

There is a paucity of evidence concerning the patterns of multi-informant agreement in populations with Autism Spectrum Disorders (ASD). This study compared ratings of behaviour and emotional problems and social functioning provided by 45 adolescents aged 12–18 years, with Autistic or Asperger's Disorder with ratings by their parents and teachers. Behaviour and emotional problems were measured using the Child Behaviour Checklist and social functioning was measured with the Social Skills Rating System. Moderate agreement was found between adolescent and parent ratings of psychopathology and social functioning. In general, parent and teacher ratings and adolescent and teacher ratings differed significantly. These findings suggest that behaviour varies across environmental contexts. Patterns of agreement between multiple informants observed in the current study frequently differed from those previously found in non-ASD populations. Clinicians and researchers need to consider a multi-informant approach to obtain a detailed picture of behaviour and emotional problems in adolescents with autism and Asperger's Disorder.

A Waitlist-Controlled Trial of Behavioral Parent Training for Fathers of Children with ADHD

Fathers, in general, have been underrepresented in studies of parent training outcome for children with attention deficit hyperactivity disorder (ADHD), and the present study aimed to investigate the efficacy of a behavioral parent training program developed expressly for fathers. The present investigation randomly assigned 55 fathers of children ages 6 to 12 with ADHD to the Coaching Our Acting-out Children: Heightening Essential Skills (COACHES) program or a waitlist control group. Outcomes for the study included objective observations of parent behaviors and parent ratings of child behavior. Results indicated that fathers in the COACHES group reduced their rates of negative talk and increased rates of praise as measured in parent–child observations, and father ratings of the intensity of problem behaviors were reduced, relative to the waitlist condition. Groups did not differ on observations of use of commands or father ratings of child behavior problems. Untreated mothers did not significantly improve on observational measures or behavioral ratings. This study provides preliminary evidence for the efficacy of the COACHES parenting program for fathers of children with ADHD. Results are cast in light of the larger literature on behavioral parent training for ADHD as well as how to best work with fathers of children with ADHD in treatment contexts.

Multiple Identification and Risks: Examination of Peer Factors Across Multiracial and Single-Race Youth

Multiracial youth are thought to be more vulnerable to peer-related risk factors than are single-race youth. However, there have been surprisingly few well-designed studies on this topic. This study empirically investigated the extent to which multiracial youth are at higher risk for peer influenced problem behavior. Data are from a representative and longitudinal sample of youth from Washington State (N=1,760, mean age=14.13, 50.9% girls). Of those in the sample, 225 youth self-identified as multiracial (12.8%), 1,259 as White (71.5%), 152 as Latino (8.6%), and 124 as Asian American (7.1%). Results show that multiracial youth have higher rates of violence and alcohol use than Whites and more marijuana use than Asian Americans. Higher levels of socioeconomic disadvantage and single-parent family status partly explained the higher rates of problem behaviors among multiracial youth. Peer risk factors of substance-using or antisocial friends were higher for multiracial youth than Whites, even after socioeconomic variables were accounted for, demonstrating a higher rate of peer risks among multiracial youth. The number of substance-using friends was the most consistently significant correlate and predictor of problems and was highest among multiracial youth. However, interaction tests did not provide consistent evidence of a stronger influence of peer risks among multiracial youth. Findings underscore the importance of a differentiated understanding of vulnerability in order to better target prevention and intervention efforts as well as the need for further research that can help identify and explain the unique experiences and vulnerabilities of multiracial youth.

Demographics, Behavior Problems, and Psychosexual Characteristics of Adolescents with Gender Identity Disorder or Transvestic Fetishism

This study provided a descriptive and quantitative comparative analysis of data from an assessment protocol for adolescents referred clinically for gender identity disorder (n = 192; 105 boys, 87 girls) or transvestic fetishism (n = 137, all boys). The protocol included information on demographics, behavior problems, and psychosexual measures. Gender identity disorder and transvestic fetishism youth had high rates of general behavior problems and poor peer relations. On the psychosexual measures, gender identity disorder patients had considerably greater cross-gender behavior and gender dysphoria than did transvestic fetishism youth and other control youth. Male gender identity disorder patients classified as having a nonhomosexual sexual orientation (in relation to birth sex) reported more indicators of transvestic fetishism than did male gender identity disorder patients classified as having a homosexual sexual orientation (in relation to birth sex). The percentage of transvestic fetishism youth and male gender identity disorder patients with a nonhomosexual sexual orientation self-reported similar degrees of behaviors pertaining to transvestic fetishism. Last, male and female gender identity disorder patients with a homosexual sexual orientation had more recalled cross-gender behavior during childhood and more concurrent cross-gender behavior and gender dysphoria than did patients with a nonhomosexual sexual orientation. The authors discuss the clinical utility of their assessment protocol.

Behavioral problems in children with motor and intellectual disabilities: Prevalence and associations with maladaptive personality and marital relationship

Prevalence rates of behavioral problems in children with motor disabilities are commonly based on questionnaires developed for a general population (e.g., Child Behavior CheckList). These questionnaires do not take into account lower levels of intellectual functioning. The first aim of this study was to examine the prevalence of parent-reported and daily caretaker-reported behavioral problems in children with motor and intellectual disabilities (MID) using the Developmental Behavior Checklist. Second, we investigated whether behavioral problems were related to sex and age. Our third and fourth aim were to determine whether behavioral problems are related to maladaptive personality traits and to marital stress and conflict. Participants were 101 Flemish children with MID (mean age=14 years 6 months). For total behavioral problems, we found prevalence rates of 18% and 8% based on parent and daily caretaker reports, respectively. Based on parent reports, twenty seven percent of the children with MID exhibited anxiety problems. Behavioral problems were not related to sex. Older children showed fewer behavioral problems than younger children. Multiple hierarchical regression analyses revealed that lower scores on Compulsivity and higher scores on Emotional Instability and Disagreeableness were related to behavioral problems. In addition to personality traits, stress and conflict in the marital relationship was also positively associated with behavioral problems. Given the importance of behavioral problems in children with MID, this study is of theoretical and clinical interest and has the potential to inform targeted clinical interventions.

Trajectory of Behavior and Emotional Problems in Autism

High rates of behavior and emotional problems have been consistently reported in children and adolescents with autism. Elevated rates of mental health problems have also been reported in adults with autism. Little is known, however, about the longitudinal development of behavior and emotional problems in autism. This study followed a cohort of children and adolescents over 18 years. Outcomes were evaluated in terms of behavior and emotional problems and autism symptomatology. The role of childhood factors (age, gender, IQ, behavior, and emotional problems) and the environment (socioeconomic disadvantage) were considered in terms of adult outcomes. Overall, improvements in comorbid behavior and emotional problems and autism symptomatology were observed. However, rates of comorbid behavior and emotional problems in adulthood remained high.

Quality of Life and Behavioural Adjustment in Childhood Hydrocephalus

The aim of the paper is to describe parent and teacher reported behavioural outcomes and quality of life in childhood hydrocephalus, and to consider the implications for future service planning. A community sample of 235 school-aged children with hydrocephalus (5-16 years) were identified via a database of service users, held by the Scottish Spina Bifida Association. Parent and teacher reports of behaviour on the Strengths and Difficulties Questionnaire (SDQ), and parent reports of quality of life on the Paediatric Quality-of-Life Generic Core (PedsQL Core) and Paediatric Quality-of-Life Fatigue (PedsQL Fatigue) were obtained, as were reports of service use and satisfaction. In total, 35% (n = 76) of parents and 86% (n = 47) of teachers who were contacted participated in the study. Parents reported behavioural difficulties in 57% and teachers in 33% of children. Quality of life was significantly reduced in comparison to published norms. Children whose parents reported unmet needs had poorer psychosocial outcomes, but families rarely accessed appropriate specialist services. In conclusion, hydrocephalus is associated with high rates of behaviour problems and markedly reduced quality of life. It is important to increase professional awareness of psychological need in this chronic neurological condition, and to increase access to appropriate psychosocial services.

Commentary: The Use of Health and Behavior Codes in a Pediatric Cardiology Setting

Congenital heart disease (CHD) is the most common birth defect, occurring in approximately 6 in 1,000 live-births (Hoffman & Kaplan, 2002). Due to advances in diagnostic and surgical techniques and postoperative management strategies, the majority of children with CHD are surviving (Tweddell et al., 2009). However, these children are at increased risk for neurodevelopmental and psychosocial problems, likely due to multiple factors including abnormal prenatal brain development, perioperative management strategies, altered cerebral blood flow and oxygen delivery, and genetic syndromes (Wernovsky Shillingford, & Gaynor, 2005). Children with CHD have lower cognitive functioning and higher rates of attentional, behavioral, and emotional problems when compared to the normal population (Brosig, Mussatto, Kuhn, & Tweddell, 2007a,b; Karsdorp, Everaerd, Kindt, & Mulder, 2007; Snookes et al., 2010). In addition, increased parental stress, as well as impaired quality of life for both children with CHD and their parents has been reported (Brosig et al., 2007b; Landolt, Valsangiacomo Buechel, & Latal, 2008; Lawoko & Soares, 2003; Uzark & Jones, 2003). Given the aforementioned problems in this patient population, in July 2007, the Pediatric Cardiology Division at our institution employed a full-time pediatric psychologist to help address the neurodevelopmental and psychosocial concerns of these children and families. Cardiologists and nurses asked families about the child’s emotional, behavioral, and academic functioning during routine cardiac follow-up clinic visits. If there were concerns in any of these areas, a referral was made to the pediatric psychologist. Based on the clinical information provided, the psychologist determined whether a separate visit with the psychologist was needed, and what type of intervention was required (e.g., psychological testing, individual therapy, health and behavior intervention, etc.). The current report summarizes our experience with financial reimbursement for pediatric psychology services in the outpatient pediatric cardiology setting over the past 4 years. We have been using the health and behavior codes at our institution since 2002, and have reported on our experience using them for inpatient pediatric psychology consultation previously (Brosig & Zahrt, 2006). We were interested to learn about reimbursement rates for health and behavior codes as well as mental health codes in the outpatient pediatric cardiology setting, as both types of services are utilized by children with CHD and their families. Results will be used to inform strategies to improve reimbursement rates for pediatric psychology services for this population.

Neuroprotection for Premature Infants?

APPROXIMATELY 85% OF INFANTS BORN WEIGHING LESS than 1500 g at birth (approximately 30 weeks’ gestational age) survive to hospital discharge. However, these surviving preterm infants, especially those at the threshold of viability (23 to 25 weeks’ gestational age) often have major developmental deficits or minor functional morbidities that interfere with daily living. One-third of children with birth weight less than 1000 g who had no neurosensory problems detected at hospital discharge had an IQ of less than 85, learning problems, or poor motor skills at 8 to 9 years of age, and two-thirds had behavioral problems; those with abnormalities identified in the newborn period had an even greater rate of adverse outcome. In the United States, preterm infants contribute more than half of all new cases of cerebral palsy and contribute disproportionately to cognitive impairment as well, although the extent is more difficult to evaluate. The resulting burden on family and societal resources is substantial. On average, a child with cerebral palsy born in 2000 incurs an estimated lifetime medical and nonmedical direct and indirect cost of nearly $1 million in 2003 dollars. The combined cost for all children with cerebral palsy, deafness, and blindness was estimated at $16 billion in 2003. Other costs that cannot easily be measured are reflected in the high rates of depression, anxiety, and behavioral problems of children with cerebral palsy and their families. An intervention that could reduce the effect of disability in preterm infants would be beneficial for the children, their families, and society as a whole. However, with the exception of antenatal corticosteroids and surfactant replacement therapy, the results of most clinical trials aimed at improving outcomes of prematurity have been disappointing. Promising short-term results are often not sustained through infancy or childhood. For example, in the Trial of Indomethacin Prophylaxis in Preterms, indomethacin administered to extremely low-birthweight infants significantly decreased the incidence of patent ductus arteriosus and periventricular and intraventricular hemorrhage. However, the rate of survival without neurosensory impairment at 18 months of age, the primary outcome of the trial, was similar in both groups. In another study that compared vitamin A supplementation with placebo, vitamin A supplementation reduced the rate of chronic lung disease in extremely low-birth-weight infants, but respiratory and neurodevelopmental outcomes were similar in both groups at 18 to 22 months of age. In this issue of JAMA, Schmidt and colleagues report the results of their 5-year follow-up of infants enrolled in the Caffeine for Apnea of Prematurity (CAP) trial. This publication is the third report from a large international trial to assess the long-term effects on neurodevelopment and growth of an agent widely used to treat apnea in preterm infants. In the CAP trial, infants with a birth weight of 500 to 1250 g whose clinicians considered treatment with a methylxanthine during the first 10 days of age were randomly assigned to receive caffeine or placebo. The indications for treatment were to prevent or treat apnea or to facilitate endotracheal extubation; treatment was continued until the clinicians thought it was no longer needed. The 18-month neurodevelopmental outcomes were measured using the Bayley Scales of Infant Development, Second Edition (BSID-II), which was the gold standard for neurodevelopmental assessment when the study was conducted. As reported previously, the primary outcome of the trial—a composite of death before 18 months and cerebral palsy, cognitive delay, severe hearing loss, or bilateral blindness at a corrected age of 18 to 21 months—occurred in 40.2% of the caffeine group compared with 46.2 percent of the placebo group (odds ratio adjusted for center, 0.77; 95% CI, 0.640.93, P=.008). Treatment with caffeine nearly halved the rate of cerebral palsy, and resulted in a modest decrease in cognitive delay. Among short-term outcomes, caffeine substantially reduced the rate of bronchopulmonary dysplasia but did not affect the rates of death, brain injury detected by ultrasonography, or necrotizing enterocolitis. In the current study, neurobehavioral, neuropsychological, and motor outcomes were comprehensively evaluated at 5 years of age. The Wechsler Preschool and Primary School Scale of Intelligence III, Child Behavior Checklist, and Move-