Ratings Of Child Behavior Problems Research Articles

Positive Family Intervention for Children with ASD: Impact on Parents’ Cognitions and Stress

While parent training often focuses on teaching parents of children with Autism Sepctrum Disorders (ASD) specific skills to address their child’s problem behavior, it has often overlooked factors related to parents’ own mental health and well-being, such as how they think and feel about their child’s behavior and their parenting. The purpose of this study was to examine the impact of positive family intervention (PFI), a parent training program which combines cognitive-behavioral therapy (CBT) with family based positive behavior support (PBS), on parents’ cognitions and children’s problem behavior for families of children with ASD. A nonconcurrent multiple baseline design across three mothers was used to examine the impact of PFI on parent-reported stress, self-efficacy, attributions, rational and irrational beliefs, pessimism, and ratings of child behavior problems. Each mother received eight weekly 90-minute PFI sessions without the child present. Findings demonstrated significant decreases in parent ratings of problem behavior as well as observed child problem behavior for all three families, though visual analysis showed only modest change in parent-reported problem behavior for one of those three mothers, and direct observation data was only collected pre- and post-intervention. Two of the three mothers reported significant decreases in dysfunctional child- and parent-causal attributions, irrational beliefs, and pessimistic thoughts. In addition, one of those two mothers reported improvements in parental stress and self-efficacy. This study suggests that there may be benefits to incorporating CBT with PBS in terms of affecting parents’ perceptions of their children and themselves. Factors potentially contributing to or limiting the effectiveness of PFI for each participant are discussed.

Resilience in Extremely Preterm/Extremely Low Birth Weight Kindergarten Children.

Research on developmental outcomes of preterm birth has traditionally focused on adverse effects. This study investigated the prevalence and correlates of resilience in 146 extremely preterm/extremely low birth weight (EPT/ELBW) children (gestational age <28 weeks and/or birth weight <1000 g) attending kindergarten and 111 term-born normal birth weight (NBW) controls. Adaptive competence (i.e., "resilience" in the EPT/ELBW group) was defined by scores within grade expectations on achievement tests and the absence of clinically elevated parent ratings of child behavior problems. The "adaptive" children who met these criteria were compared to the "maladaptive" children who did not on child and family characteristics. Additional analyses were conducted to assess the conjoint effects of group (ELBW vs. NBW) and family factors on adaptive competence. A substantial minority of the EPT/ELBW group (45%) were competent compared to a majority of NBW controls (73%), odds ratio (95% confidence interval)=0.26 (0.15, 0.45), p<.001. Adaptive competence was associated with higher cognitive skills, more favorable ratings of behavior and learning not used to define adaptive competence, and more advantaged family environments in both groups, as well as with a lower rate of earlier neurodevelopmental impairment in the EPT/ELBW group. Higher socioeconomic status and more favorable proximal home environments were associated with competence independent of group, and group differences in competence persisted across the next two school years. The findings document resilience in kindergarten children with extreme prematurity and highlight the role of environmental factors as potential influences on outcome. (JINS, 2019, 25, 362-374).

Preschool outcomes following prenatal serotonin reuptake inhibitor exposure: differences in language and behavior, but not cognitive function.

To test the hypothesis that prenatal exposure to serotonin reuptake inhibitors (SRIs) is associated with language and behavioral outcomes in preschool-aged children, while accounting for confounds such as concomitant exposures and maternal mental illness. An observational, prospective, longitudinal study of mental illness in pregnancy was conducted at a university-based women's mental health clinic (April 2010-November 2012). A sample of 178 mother-child dyads participated in a laboratory visit at preschool age (2.5-5.5 years). The majority of women (87%) received psychotropic medication during pregnancy. Psychiatric status (based on DSM-IV), other medication use, and substance use were serially assessed and tested as confounds. Primary outcome measures included standardized measures of expressive language and cognitive function and mother and alternate caregiver ratings of child behavior problems, including the Pervasive Developmental Disorders (PDD) subscale of the Child Behavior Checklist. Linear regression analyses revealed that, after controlling for relevant covariates, expressive language scores from the Test of Early Language Development, 3rd edition, were negatively associated with prenatal SRI exposure (β = -0.15, t = -2.41), while the PDD behavioral problems subscales completed by alternate caregivers and mothers were positively associated with prenatal SRI exposure (β = 0.17, t = 2.01; β = 0.16, t = 2.00, respectively). Cognitive function, measured using the Differential Ability Scales, 2nd edition, was not associated with any medication exposures. The current data suggest a small but significant association between prenatal SRI exposure and preschool outcomes, including expressive language and behavior problems. These data corroborate data from recent, population-based studies, although overall, published findings are mixed. Replication and identification of moderating risk factors are needed to understand potential clinical implications.

Child behavior problems: Mothers’ and fathers’ mental health matters today and tomorrow

Informed by a family systems framework, this study utilizes the actor-partner-interdependence model to examine how parents’ mental health, including depressive symptoms and parenting stress, predict their own (actor effects) and their partners’ (partner effects) reports of their children’s behavior problems among 730 low-income families. Further, we examine whether mothers’ and fathers’ mental health in early childhood predicts children’s teacher-reported social development in fifth grade. Both mothers’ and fathers’ depressive symptoms and parenting stress were associated with their own (actor effects) ratings of child behavior problems when children were 3 years (M=37.16 months, SD=1.53); parenting stress exerted a larger effect than depressive symptoms. Further, ratings of child behavior were predicted by partners’ parenting stress for fathers but not for mothers. Greater parent depression symptoms in early childhood was associated with higher fifth graders’ hyperactivity, and fathers’ greater depressive symptoms was associated with lower fifth graders’ cooperation. Results indicate that the mental health of both parents predicts child social skills and problem behaviors, both in early childhood and later development.

Utilization of Behavioral Therapy Services Long-Term After Traumatic Brain Injury in Young Children

ObjectiveTo examine associations of clinical need, defined by elevated parent ratings of child behavior problems and utilization of behavioral health services in young children with traumatic brain injury (TBI) and an orthopedic injury (OI) comparison group. DesignParents completed outcome measures 18 months after injury and at an extended follow-up conducted an average of 38 months postinjury. SettingChildren's hospitals and a general hospital. ParticipantsParticipants included parents of 3 groups of children injured between 3 and 7 years of age (N=139): 47 children with complicated mild to moderate TBI, 18 with severe TBI, and 74 with OI. InterventionsNot applicable. Main Outcome MeasuresParents completed ratings of child behavior, mental health symptomology, and family functioning at both visits; at the extended follow-up, they reported utilization of behavior therapy or counseling services since the 18-month follow-up visit. ResultsChildren with TBI had more behavior problems than those with OI. Although clinical need at both follow-ups was associated with greater service utilization at the extended follow-up, all groups had unmet needs as defined by a clinical need in the absence of services. Lower socioeconomic status was associated with higher rates of unmet need across groups. ConclusionsThe results document unmet long-term behavioral health needs after both TBI and OI in children and underscore the importance of monitoring and treatment of postinjury behavior problems.

Assessing Quality in Toddler Classrooms Using the CLASS-Toddler and the ITERS-R

Many very young children attend early care and education programs, but current information about the quality of center-based care for toddlers is scarce. Using 2 observation instruments, the Infant/Toddler Environment Rating Scale–Revised (ITERS-R) and the Classroom Assessment Scoring System, Toddler Version (CLASS-Toddler), 93 child care classrooms for toddlers across the state of North Carolina, representing a range of quality, were assessed to determine overall quality, and associations between observed quality and teachers' ratings of child behavior problems and competence outcomes using the Brief Infant Toddler Social Emotional Assessment. Research Findings: Findings indicated that overall, toddler classrooms were rated as being of moderate quality. Associations between observed quality and teacher-reported child behavior problems and competence outcomes indicated that CLASS-Toddler ratings were positively associated with fewer behavior problems; specifically, children in classrooms with higher levels on the CLASS-Toddler domains of Emotional and Behavioral Support as well as Engaged Support for Learning were reported to have fewer behavior problems. Similarly, the ITERS-R subscales of Interaction and Listening and Talking were positively related to fewer reported behavior problems. Regression models showed that the CLASS-Toddler Emotional and Behavioral Support domain predicted differences in child behavior problems. Practice or Policy: Findings suggest the need for additional research related to very young children's experiences in center-based child care to examine associations between quality and child experiences and outcomes. Children's experiences over time need to be examined to understand how these early child care experiences are related to children's later school adjustment and performance. On a related note, professional development for teachers in toddler classrooms needs to be addressed in terms of preparing effective teachers for young children during the toddler developmental period.

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.

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.

Promoting Effective Parenting Practices and Preventing Child Behavior Problems in School Among Ethnically Diverse Families From Underserved, Urban Communities

This study examines the efficacy of ParentCorps among 4-year-old children (N = 171) enrolled in prekindergarten in schools in a large urban school district. ParentCorps includes a series of 13 group sessions for parents and children held at the school during early evening hours and facilitated by teachers and mental health professionals. ParentCorps resulted in significant benefits on effective parenting practices and teacher ratings of child behavior problems in school. Intervention effects were of similar magnitude for families at different levels of risk and for Black and Latino families. The number of sessions attended was related to improvements in parenting. Study findings support investment in and further study of school-based family interventions for children from underserved, urban communities.

Mother reports of maternal support following child sexual abuse: Preliminary psychometric data on the Maternal Self-report Support Questionnaire (MSSQ)

Objective Maternal support is an important factor in predicting outcomes following disclosure of child sexual abuse; however, definition of the construct has been unclear and existing measures of maternal support are utilized inconsistently and have limited psychometric data. The purpose of this study was to develop a reliable and valid mother-report measure for assessing maternal support following the disclosure of child sexual abuse. Methods Data from 2 very similar samples of mother-child pairs seeking forensic evaluation following the discovery of child sexual abuse were combined, resulting in a final sample of 246. Results Exploratory factor analysis resulted in two reliable 7-item factors labeled “Emotional Support” and “Blame/Doubt,” each of which had acceptable internal consistency. Analyses with a child-report measure of general maternal support the construct validity of the MSSQ. Concurrent validity analyses revealed unique relations with maternal ratings of child behavior problems and case characteristic data. Conclusions The study resulted in the development of a brief, easily scored self-report measure of maternal support with reasonable preliminary psychometric properties that could easily be utilized in other studies of sexually abused children. Practice implications Adoption of this promising measure in future research will reduce the lack of cross-study measurement comparability that has characterized the maternal support literature to date, increase the feasibility of expanding upon current literature on maternal support, and may produce important information leading to clinical and theoretical innovation.

Children's Cognitive-Behavioral Functioning at Age 6 and 7: Prenatal Drug Exposure and Caregiving Environment

The aim of this study was to examine how prenatal drug exposure (PDE) and caregiving environment relate to cognitive, academic, and behavioral performance at ages 6 and 7. A longitudinal follow-up was conducted of 111 children with PDE and a community cohort of 62 non-drug-exposed children (N = 173). Children completed standardized tests of cognition (Stanford-Binet Intelligence Scales, Fourth Edition [SB-IV]) and academic performance (Wide Range Achievement Test 3). Caregivers completed ratings of child behavior problems (Child Behavior Checklist [CBCL]). Multivariate analyses were conducted, adjusting for gender, prenatal tobacco exposure, number of caregiver placement changes, and 3 caregiver variables assessed at age 7, including depressive symptoms, employment status, and public assistance status. After adjusting for perinatal and environmental variables, there were no significant exposure-group differences in cognition, academic performance, or behavior problems. In comparison with males, females had higher scores on overall IQ and 4 of 8 SB-IV subtests, fewer caregiver-reported attention and aggression problems, and higher reading achievement scores. There were no significant gender-by-group interactions. When analyses were adjusted for perinatal and environmental variables, most associations between PDE and cognitive-behavioral functioning were attenuated. Regardless of drug exposure history, males performed more poorly than females on multiple cognitive-behavioral indices. Both exposed and nonexposed children were from low-income families and obtained scores substantially below normative expectations.

The Impact of the Big Five Personality Traits on Reports of Child Behavior Problems by Different Informants

The present study compared ratings of a standardized sample of child behavior problems across informants and examined the effects of informant personality traits on child behavior ratings by mothers, teachers, and group-care workers. Participants were 55 clinic-referred children, aged 6-12 years. All informants watched and rated the same 17-min videotaped behavior sample of a familiar target child. Independent trained observers rated the same videotapes to provide criterion ratings. Informants' personality traits were assessed using the NEO Five Factor Personality Inventory. Results showed that mothers reported fewer behavior problems than did the professionals, that the informants who were familiar with the child reported more behavior problems than did the independent observers, and that higher levels of informant neuroticism were related to higher ratings of child behavior problems in the case of the professionals, but not in the case of the mothers. In addition, group-care workers who were less extraverted and open were likely to report more child behavior problems than group-care workers with normal levels of extraversion and openness. Finally, no relations were found between agreeableness or conscientiousness and ratings of child behavior. Findings suggest that professionals who work with children are not immune to distortions based on their own personality.

An Intervention to Decrease Uncertainty and Distress Among Parents of Children Newly Diagnosed With Diabetes: A Pilot Study.

This pilot study reports findings from a randomized clinical trial of a novel intervention for parents of children newly diagnosed with Type 1 diabetes. The intervention was designed to decrease parental uncertainty and distress as well as child behavioral problems by teaching parents skills to manage uncertainty. Thirty-four families were randomly assigned to either an intervention (IG) or a treatment as usual (TAU) group. Parents completed measures of distress, uncertainty, and child behavior problems at baseline, 1 month, and 6 months postintervention. In the IG, significant reductions were observed for maternal and paternal distress as well as maternal ratings of child behavior problems. No changes were observed for the TAU, except for father-reported reductions in child internalizing symptoms at 1 month postintervention. Preliminary data suggest that, with further development and testing, the intervention has potential to be an effective tool to reduce paternal distress and possibly child behavior problems.

Child-Related Disagreements, Verbal Aggression, and Children's Internalizing and Externalizing Behavior Problems.

Dual-income parents (N = 122 couples) with an oldest child 18-60 months of age completed the Child-Rearing Disagreements Scale (E. N. Jouriles et al., 1991), the Child Behavior Checklist (T. M. Achenbach & L. A. Rescorla, 2000), and the Verbal Aggression subscale of the Conflicts and Problem-Solving Scale (P. K. Kerig, 1996). Replicating the results of E. N. Jouriles et al. (1991) and extending these findings to daughters and fathers, the authors found links between child-related disagreements and parental ratings of child behavior problems in this low-risk sample. There were no links between fathers' reports of verbal aggression and child behavior problems. Among mothers, however, use of verbal aggression mediated the link between child-related disagreements and ratings of sons' internalizing problems. Verbal aggression did not moderate the link between child-related disagreements and child behavior problems for either mothers or for fathers.

Patterns of agreement between parent and child ratings of emotional and behavioral problems in an outpatient clinical setting: when children endorse more problems.

This study examined clinically relevant patterns of agreement between parent and child ratings of child behavior problems and factors associated with these patterns. Subjects were 274 children, ages 11 to 18 years, and their parents. Overall agreement between parent-child ratings was modest. Twenty-five percent of parent-child pairs agreed children's behavior problems were clinically elevated ("both" group), 29% agreed problems were nonclinical ("neither" group), in 39% of pairs only parents reported clinically elevated problems ("parent only" group) and in 8% of pairs only children rated clinically elevated problems ("child only" group). Maternal stress and child age, but not child gender, were associated with parent-child agreement patterns. Children with depressive/mood disorders were more likely to be in the "child only" group than in any other group. This study discusses the importance of paying attention to child reports of elevated behavior problems, particularly when parents report that child behavior problems are not clinically elevated.

An Examination of Children Exposed to Marital Violence Accessing a Treatment Intervention

SUMMARY This study examines the well-being of families accessing treatment due to children's exposure to marital violence. Participants were 47 children, aged 6–12 years, enrolled in a 10-week group treatment intervention and one of their parents who were attending a corresponding parenting group. Measures were administered prior to the commencement of the programs and again in the ninth week of the interventions. Children completed self-report measures of anxiety, depression, posttraumatic stress and associated symptoms, and knowledge of abuse and safety planning. Parents reported on child competence and behavior problems, as well as their own experience of stress. Results indicated elevated rates of clinical scores on several measures compared with normative data. Parental stress was significantly correlated with reported child behavior problems, anxiety, depression, and posttraumatic stress symptoms. Scores at the second assessment indicated significant changes in ratings of child behavior problems, pa...

The Infant-Toddler Social and Emotional Assessment (ITSEA): factor structure, reliability, and validity.

In this paper the refinement and psychometric properties of the Infant-Toddler Social and Emotional Assessment (ITSEA) are described. Results from a sociodemographically diverse birth cohort sample of 1,235 parents of children between the ages of 12 and 36 months are presented. Confirmatory factor analyses supported the hypothesized Internalizing, Externalizing, Regulatory, and Competence domains as well as the 17 individual scales that comprise the ITSEA. Findings for 3 additional indices useful in identifying significant psychopathology are presented. Subgroup analyses revealed structural invariance and expected mean level differences across both child sex and 6-month age bands. Child sex differences emerged for some problem and most competence scales, with boys rated as higher on Activity/Impulsivity and girls rated higher on Anxiety and most Competence scales. All competence scores increased across age groups. Problem behaviors showed a more mixed developmental pattern. Test-retest and interrater reliability were acceptable. Associations between the ITSEA and independent evaluator ratings and parental ratings of child behavior problems, temperament, and parental distress support the validity of the instrument.

Influence of parental stress and social support on the behavioral adjustment of children with transposition of the great arteries.

The joint role of parent stress and social support in the emotional adjustment of children was examined prospectively in a group of children with d-transposition of the great arteries (d-TGA). Questionnaires on parent perceptions of stress and social support were administered when children were 1 and 4 years of age (n = 143-153). Parent ratings of child behavior problems were collected at 4 years (n = 152). The findings indicate a favorable outcome for parents and children with congenital heart disease (CHD). Compared with normative samples, parents experienced less stress and more social support, and they rated children as showing fewer behavior problems. Parents with more stress at both ages reported more behavior problems. Families with less social support reported more stress at both 1 and 4 years. Social support, however, did not moderate the relationship between stress and child behavior problems. Early detection of distressed families may assist in alleviating stress and reducing behavior problems.

Daily Behavior Ratings Among Child and Adolescent Inpatients: The Abbreviated Child Behavior Rating Form

Child and adolescent psychiatric inpatient facilities are in need of standardized behavior rating scales to assess continuous change in patient behaviors. This study used daily staff ratings to examine the factor structure and psychometric properties of an abbreviated version of the Child Behavior Rating Form (CBRF-A). Three hundred eighty-seven inpatients, aged 3 to 17 years, were rated daily by unit staff. Subsamples of patients and/or their parents completed additional measures of behavior problems (Child Behavior Checklist, Functional Impairment Scale for Children and Adolescents) to assess the instrument's validity. Confirmatory factor analyses identified 5 behavior problem dimensions (Oppositionalism, Attention Problems, Overactivity, Withdrawal/Depression, and Anxiety), a second-order Externalizing dimension, and 2 positive behavior dimensions (Positive/Adaptive Social and Compliance/Self-Control). The scales were found to be internally consistent and showed expected age differences, and the scale factor structures were relatively stable over 1- and 2-week intervals. The scales correlated meaningfully with parent ratings of child behavior problems and functional impairment and were predictive of total hospital days. The psychometric properties of the CBRF-A appear adequate for daily inpatient rating; additional research is needed to determine the usefulness of the CBRF-A in assessing treatment and medication effects over the hospital stay.

Relation between maternal characteristics and child behavior ratings. Implications for interpreting behavior checklists.

The present study examined the extent to which mothers' ratings of their psychological distress, marital adjustment, and negative life events were related to maternal ratings of child behavior problems. Data were collected from mothers of 110 children (ages 2 to 12 years) who were referred to a pediatric clinic for a variety of common behavioral concerns. Maternal psychological distress and marital adjustment were significantly correlated with mothers' ratings on a child behavior checklist. Maternal psychological distress also accounted for a significant amount of the variance in maternal child behavior ratings over and above that accounted for by fathers' ratings of the same behaviors. Given that maternal characteristics co-vary significantly with reports of child behavior problems, pediatricians should interpret findings derived from child behavior rating scales within the overall family context.