Assessing the influence of maternal depression on the validity of the Child Behavior Checklist

Caregiving stress and maternal mental health during the COVID-19 pandemic

It has now been extensively documented that parental mental health has deteriorated since the beginning of the COVID-19 pandemic. Although pandemic-related stress has been widespread, parents faced the unique challenge of navigating remote schooling. Parental oversight of children's education, loss of access to school supportive resources, and the challenges of remote learning may have been most problematic for parents of children with or at elevated risk for mental health difficulties. In the current study, we examined interactive effects of parent-reported pandemic-related caregiving stress and child internalizing and externalizing problems on parental depressive symptoms in a community-based cohort (N = 115) in the Northeast of the United States. Results indicated that parents experiencing higher levels of pandemic-related caregiving stress whose children exhibited elevated externalizing behaviors reported heightened levels of depressive symptoms. Greater child internalizing problems were associated with higher parental depressive symptoms independent of caregiving stress. These findings point to conditions that might heighten risk for parent mental health challenges in the context of ongoing remote or hybrid learning and pandemic-associated restrictions. Further, the findings point to conditions and characteristics that may be screened to identify and intervene with vulnerable families to mitigate mental health problems.

Context-dependent approach and avoidance behavioral profiles as predictors of psychopathology

Inhibition (a temperamental profile characterized by elevated levels of avoidance behaviors) is associated with increased likelihood for developing anxiety and depression, whereas exuberance (a temperamental profile characterized by elevated levels of approach behaviors) is associated with increased likelihood for developing externalizing conditions (e.g., attention deficit/hyperactivity disorder and conduct disorder). However, not all children who exhibit high levels of approach or avoidance behaviors develop emotional or behavioral problems. In this preregistered study, we assessed context-dependent profiles of approach and avoidance behaviors in 3-year-old children (N = 366). Using latent profile analysis, four groups were identified: nonsocial approachers, social approachers, social avoiders, and nonsocial avoiders. Analyses revealed that there were minimal differences in internalizing and externalizing symptoms across the four context-dependent groups. However, exploratory analyses assessed whether high levels of approach or avoidance combined across contexts, similar to findings reported in prior work, were related to psychopathology. Children identified as high in avoidance behavior at 3 years of age were more likely to show internalizing symptoms at 3 years of age but not at 5 years of age. Children high in approach were more likely to meet criteria for anxiety and externalizing disorders by age 5 years. These findings further our understanding of individual differences in how young children adjust their behavior based on contextual cues and may inform methods for identifying children at increased likelihood for the development of emotional and behavioral problems. RESEARCH HIGHLIGHTS: Context-dependent approach and avoidance profiles were identified in 3-year-old children using a person-centered approach. Children who were high in approach behavior, regardless of context, at age three had a higher likelihood for developing an anxiety or externalizing disorder by age five. These findings may help identify children at increased risk of developing emotional and behavioral problems.

Postnatal maternal depressive symptoms and behavioural outcomes in term-born and preterm-born toddlers: a longitudinal UK community cohort study

OBJECTIVES

To examine the association between maternal depressive symptoms in the immediate postnatal period and offspring's behavioural outcomes in a large cohort of term-born and preterm-born toddlers.

DESIGN AND PARTICIPANTS

Data were drawn from the Developing Human Connectome Project. Maternal postnatal depressive symptoms were assessed at term-equivalent age, and children's outcomes were evaluated at a median corrected age of 18.4 months (range 17.3-24.3).

EXPOSURE AND OUTCOMES

Preterm birth was defined as <37 weeks completed gestation. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS). Toddlers' outcome measures were parent-rated Child Behaviour Checklist 11/2-5 Total (CBCL) and Quantitative Checklist for Autism in Toddlers (Q-CHAT) scores. Toddlers' cognition was assessed with the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III).

RESULTS

Higher maternal EPDS scores were associated with toddlers' higher CBCL (B=0.93, 95% CI 0.43 to 1.44, p<0.001, f2=0.05) and Q-CHAT scores (B=0.27, 95% CI 0.03 to 0.52, p=0.031, f2=0.01). Maternal EPDS, toddlers' CBCL and Q-CHAT scores did not differ between preterm (n=97; 19.1% of the total sample) and term participants. Maternal EPDS score did not disproportionately affect preterm children with respect to CBCL or Q-CHAT scores.

CONCLUSIONS

Our findings indicate that children whose mothers reported increased depressive symptoms in the early postnatal period, including subclinical symptoms, exhibit more parent-reported behavioural problems in toddlerhood. These associations were independent of gestational age. Further research is needed to confirm the clinical significance of these findings.

Parenting stress mediates the longitudinal effect of maternal depression on child anxiety/depressive symptoms

BACKGROUND

Evidence is lacking for the longitudinal bidirectional relationship between maternal depression and child anxiety/depressive symptoms through pre-school to adolescence and regarding parenting stress as having a mediating effect on this association.

METHODS

We performed a secondary analysis of data from the Fragile Families and Child Well-being Study (n = 1,446 child-mother dyads in 20 main U.S. cities) collected at baseline, Year-5 (T1), Year-9 (T2) and Year-15 (T3) (from 1998 to 2017). Maternal depression, child anxiety/depressive symptoms and parenting stress were assessed at three time points (T1-T3). The associations were evaluated using autoregressive cross-lagged panel models.

RESULTS

Cross-lagged models indicated that 1) maternal depression significantly predicted subsequent higher child anxiety/depressive symptoms across all time points, and 2) greater child anxiety/depressive symptoms significantly predicted subsequent maternal depression across all time points. Furthermore, T1 maternal depression was indirectly associated with T3 child anxiety/depressive symptoms via T2 parenting stress [b = 0.010 (SE=0.004), p = 0.017]. However, T2 parenting stress did not significantly mediate the association between T1 child anxiety/depressive symptoms and T3 maternal depression [b = 0.004 (SE=0.004), p = 0.256].

LIMITATIONS

The FFCWS oversampled unmarried parents and had a higher proportion of socio-economically disadvantaged racial and ethnic minority families, limiting the generalizability of findings.

CONCLUSIONS

Maternal depression is indirectly linked to child anxiety/depressive symptoms via parenting stress.

Maternal mental health and early childhood development: Exploring critical periods and unique sources of support

BACKGROUND

The objective of this study was to explore associations between maternal depression and anxiety during early sensitive periods, child social-emotional and behavioral problems and the moderating roles of financial, instrumental, and partner emotional support.

METHODS

Analyses was conducted using data from the Fragile Families and Child Wellbeing Study. Hierarchical linear regression modeling was used to explore associations between maternal depression and anxiety at 1- and 3-years postpartum, three unique types of social support, and childhood behavioral problems at 5-years of age (n = 2,827).

RESULTS

Mothers who were depressed at one or both timepoints, compared to nondepressed mothers, reported higher externalizing behavioral problems scores of 1.96 and 2.90, and internalizing behavioral problems scores of 1.16 and 2.20, respectively, at 5-years of age (both p < .01), after controlling for covariates. Financial, instrumental, and partner emotional support were independently and inversely associated with behavioral problems (p < .05); however, none of these types of support moderated the relationship between maternal depression and behavioral problems, after controlling for covariates.

IMPLICATIONS

Promoting maternal mental health as well as different sources of support throughout the first five years of life, instead of one critical period, may help to reduce the burden of chronic disease in the next generation.

Early-Life Somatic Complaints: Longitudinal Associations with Maternal and Child Psychopathology

OBJECTIVE

Somatic complaints, often associated with concurrent and future internalizing symptoms and disorders in adult samples, were examined longitudinally from preschool to school age in a sample of children at an increased familial risk for psychopathology. The behavioral correlates and sex differences of somatic complaints and the persistence of these complaints across early childhood were examined.

METHOD

A longitudinal sample of 185 mothers completed a laboratory visit when children were preschool aged and an online follow-up when children were school aged. Mothers were assessed for psychopathology, and mothers and secondary caregivers reported on children's somatic complaints, anxiety, and depression at both time points.

RESULTS

A high rate of child's somatic complaints was noted in this sample, with similar rates in males and females. Regression analyses revealed that somatic complaints at preschool predicted somatic complaints, anxiety, and depression at school age, and sex did not moderate these relationships. Overall, maternal psychopathology predicted somatic complaints, but findings were inconsistent across reporters, time points, and types of maternal psychopathology. Evidence for maternal reporting bias was mixed.

CONCLUSION

The association between preschool-age somatic complaints and school-age internalizing symptoms suggests the potential utility of early detection and treatment of somatic complaints, particularly for young children at an increased familial risk for developing internalizing disorders. Pediatric primary care is an ideal setting for these early intervention efforts.

Utility-based quality of life in mothers of children with behaviour problems: A population-based study

AIM

To examine the relationship between mothers' health-related quality of life (HRQoL) and child behaviour problems at age 2 years. To investigate whether the relationship between maternal HRQoL and child behaviour problems is independent of maternal mental health.

METHODS

Cross-sectional survey nested within a population-level, cluster randomised trial, which aims to prevent early child behaviour problems. One hundred and sixty mothers of 2-year-old children, in nine local government areas in Victoria, Australia. HRQoL was measured using the Assessment of Quality of Life 6D and child behaviour was measured using the child behaviour checklist (CBCL/1.5-5 years). Maternal mental health was measured using the Depression Anxiety Stress Scale. Data were collected at child age 2 years; demographic data were collected at child age 8 months.

RESULTS

HRQoL was lower for mothers with children that had borderline/clinical behaviour problems compared to those with children without problems (mean difference -0.14, 95% confidence interval (CI): -0.16 to -0.12, P < 0.001). The finding did not markedly change when adjusting for household income, financial security, child gender, child temperament and intervention group status at child age 8 months (mean difference -0.12, 95% CI: -0.15 to -0.09, P < 0.001), but did attenuate when additionally adjusting for concurrent maternal mental health (mean difference -0.03, 95% CI: -0.05 to -0.02, P < 0.001).

CONCLUSIONS

Child behaviour problems were associated with lower maternal HRQoL. Child behaviour problems prevention programmes could consider this association with maternal HRQoL and be designed to improve and report both mothers' and their child's health and wellbeing.

Study of the catechol-o-methyltransferase (COMT) gene with high aggression in children

The etiology of childhood-onset aggression (COA) is poorly understood, but early COA can be considered as a strong risk factor for adult delinquency and criminal behavior. Callous-unemotional (CU) traits have been proposed as a developmental model of antisocial behavior. Catechol O-methyltransferase (COMT) has been associated with aggression, attention deficit/hyperactivity disorder (ADHD), and other psychiatric disorders. We report an association study between COMT single-nucleotide polymorphisms (SNPs), childhood aggression, and the CU trait in our sample of 144 children with scores at or exceeding the 90th percentile on the aggression subscale of the parent-reported Child Behavior Checklist and the Teacher's Report Form. The genotype analysis of rs6269 showed nominally significant association (P = .019) and rs4818 showed a trend (P = .064) with COA. Trends were observed for rs6269 and rs4818 with CU scores (P < .10) as well. The analyses stratified by ADHD, or gender showed no significant results. This is the first report to our knowledge evaluating COMT SNPs with the phenotype of high aggression in children with a possible role for the COMT marker in CU traits. Given the importance of CU traits in antisocial behavior, further investigation of COMT is warranted.

The dysregulation profile predicts cannabis use in the offspring of teenage mothers

Background. Offspring of teenage mothers are at greater risk of early drug use. Research has identified a child behavior checklist (CBCL) profile for children with high levels of comorbid behavior problems, the dysregulation profile (DP), as another risk factor for drug use. Method. Teenage girls (12–18 years old; 71% African-American, 29% White) were recruited during pregnancy. Data were collected during pregnancy and when offspring were 6, 10, and 14 years old (n = 318). Mothers completed the CBCL when children were at ages 6 and 10, and children who scored 60 or higher on all 3 DP subscales (aggression, anxiety/depression, and attention problems) were categorized as dysregulated. At ages 10 and 14, the offspring (50% male, 50% female) reported on their cannabis use and completed the childhood depression inventory (CDI). Results. DP at age 6 and depressive symptoms at age 14 predicted recent cannabis use in the offspring. There was a significant interaction between race and pubertal timing such that White offspring who matured earlier were at greater risk of recent cannabis use. Conclusions. The results of this study suggest that it may be possible to identify a subset of children at risk of dual diagnosis as early as age 6.

The relations among maternal depressive disorder, maternal expressed emotion, and toddler behavior problems and attachment

Direct and indirect relations among maternal depression, maternal Expressed Emotion (EE: Self- and Child-Criticism), child internalizing and externalizing symptoms, and child attachment were examined. Participants were mothers with depression (n = 130) and comparison mothers (n = 68) and their toddlers (M age = 20 mo.; 53% male). Assessments included the Diagnostic Interview Schedule (maternal depression); the Five Minute Speech Sample (EE); the Child Behavior Checklist (toddler behavior problems); the Strange Situation (child attachment). Direct relations were significant linking: 1) maternal depression with both EE and child functioning; 2) Child-Criticism with child internalizing and externalizing symptoms; 3) Self-Criticism with child attachment. Significant indirect relations were found linking maternal depression with: 1) child externalizing behaviors via Child-Criticism; 2) child internalizing behaviors via Self- and Child-Criticism; and 3) child attachment via Self-Criticism. Findings are consistent with a conceptual model in which maternal EE mediates relations between maternal depression and toddler socio-emotional functioning.

Should we get married? The effect of parents' marriage on out-of-wedlock children

Using a representative sample of children all born to unwed parents drawn from the Fragile Families and Child Wellbeing Study and a potential outcome approach to account for self-selection into marriage, we investigate whether marriage after childbearing has a causal effect on early child development. Comparing children with similar background characteristics and parental mate-selection patterns who differ only in terms of whether their parents marry after childbirth, we find that marriage after childbirth significantly increases a child's early cognitive performance but there is no evidence that it affects child asthma risk or behavioral outcomes.

Does competence mediate the associations between puberty and internalizing or externalizing problems in adolescent girls?

PURPOSE

To examine separate mediational models linking (a) menarcheal status or (b) pubertal timing to internalizing and externalizing problems through competence.

METHOD

This study involved cross-sectional analyses of 262 adolescent girls (age: 11-17 years; mean = 14.93, standard deviation = 2.17) enrolled in a longitudinal study examining the association of psychological functioning and smoking with reproductive and bone health. Measures of menarcheal status (pre/post), pubertal timing (early, on-time, or late), internalizing and externalizing behavior, and perceived competence (parent and adolescent report) were obtained. Structural equation modeling was used for analyses.

RESULTS

Perceived competence was found to fully mediate the association between menarcheal status and parent report of internalizing and externalizing problems. For adolescent report, there was a full mediation effect for internalizing problems but a partial mediation effect for externalizing problems. Being menarcheal was related to lower competence, which was in turn related to higher internalizing and externalizing problems. Models including pubertal timing were not significant.

CONCLUSIONS

Perceived competence is important in understanding the associations between menarcheal status and internalizing and externalizing problems. Interventions targeting competence, particularly in postmenarcheal girls, may reduce or prevent problem behaviors.

Maternal depressive symptomatology and child behavior: transactional relationship with simultaneous bidirectional coupling

The present study investigated reciprocal relationships between adolescent mothers and their children's well-being through an analysis of the coupling relationship of mothers' depressive symptomatology and children's internalizing and externalizing behaviors. Unlike studies using discrete time analyses, the present study used dynamical systems to model time continuously, which allowed for the study of dynamic, transactional effects between members of each dyad. Findings provided evidence of coupling between maternal depressive symptoms and children's behaviors. The most robust finding was that as maternal depressive symptoms became more or less severe, children's behavior problems increased or decreased in a reciprocal manner. Results from this study extended upon theoretical contributions of such authors as Richters (1997) and Granic and Hollenstein (2003), providing empirical validation from a longitudinal study for understanding the ongoing, dynamic relationships between at-risk mothers and their children.

Caregiver and self-report of mental health symptoms in 9-year old children with prenatal cocaine exposure

OBJECTIVE

To assess the effect of prenatal cocaine exposure on mental health symptoms in 9-year old children controlling for potential confounders.

METHODS

332 children (170 prenatally cocaine-exposed (PCE), 162 non cocaine-exposed (NCE) were assessed using self (Dominic Interactive; DI) and caregiver report (Child Behavior Checklist; CBCL).

RESULTS

Higher levels of PCE were associated with caregiver report of clinically elevated aggressive and delinquent behavior. With each increased unit of PCE, children were 1.3 times more likely to be rated as aggressive (OR=1.30, 95% CI: 1.02-1.67, p<0.04). For each increased unit of PCE, girls were 2 times more likely to be rated as having delinquent behavior (OR=2.08, 95% CI: 1.46-2.96, p<0.0001). PCE status was also associated with increased odds of delinquent behavior (OR=2.41; 95% CI: 1.16-4.97, p=0.02), primarily due to the increased risk among girls with PCE. While girls with PCE status were 7 times more likely than NCE girls to have delinquent behaviors (OR=7.42; 95% CI: 2.03-27.11, p<0.002) boys with PCE did not demonstrate increased risk (OR=0.98; 95% CI: 0.36-2.65, p>0.97). Foster or adoptive parents were more likely to rate their PCE children as having more thought problems, inattention, delinquent behavior, aggression, externalizing and overall problems (p<0.05) than biologic mothers or relative caregivers. Higher 2nd trimester tobacco exposure was associated with increased odds of caregiver reported anxiety (OR=1.73; 95% CI 1.06-2.81, p<0.03) and marijuana exposure increased the odds of thought problems (OR=1.68; 95% CI 1.01-2.79, p<0.05). Children with PCE self-reported fewer symptoms of oppositional defiant disorder (ODD) compared to NCE children (OR=0.44, 95% CI: 0.21-0.92, p<0.03). Greater tobacco exposure was associated with increased odds of child reported ODD (OR=1.24; 95% CI 1.03-1.78, p<0.03).

CONCLUSION

Higher PCE was associated with disruptive behaviors including aggression and delinquent behavior among girls by caregiver report, but not child report. These findings highlight the need for early behavioral assessment using multiple informants in multi-risk children.

Changes in parental depression symptoms during family preservation services

OBJECTIVES

Parental depression symptoms often change over the course of child welfare family preservation and parenting services. This raises the question of whether certain processes in family preservation services might be associated with depression symptom change. This study tests three correlational models of change among family preservation service participants: (a) changes in depression symptoms are one facet of broad general changes in wellbeing; (b) the quality of the home visitor-client relationship is associated depression symptom changes; and (c) linking parents to adjunctive services is associated with symptom changes.

METHODS

Participants were 2,175 parents in family preservation services, largely for child neglect, who were surveyed using standard measures at pre-treatment, post-treatment and 6 month follow-up. Change patterns were evaluated using growth models, including bivariate parallel and multivariate second-order models.

RESULTS

Parallel growth was noted among depression symptoms and changes in social, economic, familial, and parenting domains. A second order change model positing a global change pattern fit the data well. Working alliance had a modest association with improvement, but successful linkage to outside mental health services was not associated with improvement.

CONCLUSIONS

Changes in diverse indicators of wellbeing follow a global pattern which might support use of less complex rather than more fully comprehensive service plans. Findings about lack of adjunctive usual care mental health service benefit may be related to uncontrolled factors and this is a topic in need of additional study.

Fragile families and child wellbeing

Jane Waldfogel, Terry-Ann Craigie, and Jeanne Brooks-Gunn review recent studies that use data from the Fragile Families and Child Wellbeing Study (FFCWS) to examine why children who grow up in single-mother and cohabiting families fare worse than children born into married-couple households. They also present findings from their own new research. Analysts have investigated five key pathways through which family structure might influence child well-being: parental resources, parental mental health, parental relationship quality, parenting quality, and father involvement. It is also important to consider the role of the selection of different types of men and women into different family types, as well as family stability. But analysts remain uncertain how each of these elements shapes children's outcomes. In addition to providing an overview of findings from other studies using FFCWS, Waldfogel, Craigie, and Brooks-Gunn report their own estimates of the effect of a consistently defined set of family structure and stability categories on cognitive, behavioral, and health outcomes of children in the FFCWS study at age five. The authors find that the links between fragile families and child outcomes are not uniform. Family instability, for example, seems to matter more than family structure for cognitive and health outcomes, whereas growing up with a single mother (whether that family structure is stable or unstable over time) seems to matter more than instability for behavior problems. Overall, their results are consistent with other research findings that children raised by stable single or cohabiting parents are at less risk than those raised by unstable single or cohabiting parents. The authors conclude by pointing to three types of policy reforms that could improve outcomes for children. The first is to reduce the share of children growing up in fragile families (for example, through reducing the rate of unwed births or promoting family stability among unwed parents). The second is to address the pathways that place such children at risk (for example, through boosting resources in single-parent homes or fostering father involvement in fragile families). The third is to address directly the risks these children face (for example, through high-quality early childhood education or home-visiting policies).

The effects of prenatal cocaine exposure on problem behavior in children 4-10 years

BACKGROUND

Children prenatally exposed to cocaine may be at increased risk for behavioral problems due to disruptions of monaminergically regulated arousal systems and/or environmental conditions.

OBJECTIVE

To assess behavioral outcomes of cocaine (CE) and non-cocaine-exposed (NCE) children, 4 through 10 years old, controlling for other prenatal drug exposures and environmental factors.

METHODS

Low socioeconomic status (SES), primarily African American children (n=381 (193 (CE), 188 (NCE)) were recruited from birth. Generalized Estimating Equation (GEE) analyses were used to assess the predictive relationship of prenatal cocaine exposure to odds of caregiver reported clinically elevated behavioral problems at 4, 6, 9 and 10y ears of age, controlling for confounders.

RESULTS

Prenatal cocaine exposure was associated with increased rates of caregiver reported delinquency (OR=1.93, CI: 1.09-3.42, p<0.02). A significant prenatal cocaine exposure by sex interaction was found for delinquency indicating that only females were affected (OR=3.57, CI: 1.67-7.60, p<0.001). There was no effect of cocaine on increased odds of other CBCL subscales. Higher prenatal tobacco exposure was associated with increased odds of externalizing symptoms at 4, 9 and 10 years of age. For CE children, those in foster or adoptive care were rated as having more behavior problems than those in biologic mother or relative care. Greater caregiver psychological distress was associated with increased behavioral problems. There were no independent effects of elevated blood lead level on increased behavior problems after control for prenatal drug exposure and other environmental conditions.

CONCLUSION

Prenatal cocaine and tobacco exposure were associated with greater externalizing behavior after control for multiple prenatal drug exposures, other environmental and caregiving factors and lead exposure from 4 through 10 years of age. Greater caregiver psychological distress negatively affected caregiver ratings of all CBCL domains. Since cocaine and tobacco use during pregnancy and maternal psychological distress have the potential to be altered through prenatal educational, drug treatment and mental health interventions, they warrant attention in efforts to reduce rates of problem behaviors in children.

Perceived competence and contraceptive use during adolescence

BACKGROUND

Little is known about psychosocial correlates of different contraceptive methods in adolescence.

STUDY DESIGN

Cross-sectional analyses of 209 postmenarcheal girls [mean age (years)+/-SD=15.68+/-1.74], primarily Caucasian (62.8%) or African American (32.8%). Competence (activities and social) and rule-breaking behavior were assessed by the Youth Self Report (YSR; adolescent) and the Child Behavior Checklist (CBCL; parent). Three contraceptive-use groups were created: no hormonal contraceptive (n=142), combined oral contraceptives or the transdermal patch (COCs/patch, n=41), and depot medroxyprogesterone acetate (DMPA, n=20).

RESULTS

There was a significant effect of contraceptive-use group on competence (p=.003). The DMPA group had lower competence (CBCL activities and social; YSR social) than the no-hormonal-contraceptive and COCs/patch groups. The COCs/patch group scored lower than the no-hormonal-contraceptive group on YSR activities competence, but was not different from the DMPA group. Lastly, there was an effect of contraceptive-use group on CBCL (but not YSR) rule-breaking behavior (p=.029) with the DMPA group having higher rule-breaking behavior than the other groups.

CONCLUSIONS

Type of contraceptive method was associated with parent and adolescent's perceived competence. For rule-breaking behavior, parental perception may be more relevant to contraceptive use.

Depressed Mood and Maternal Report of Child Behavior Problems: Another Look at the Depression-Distortion Hypothesis

Caregiver depression has been described as leading to overreport of child behavior problems. This study examines this "depression-distortion" hypothesis in terms of high-risk families of young adolescents. Questionnaire and diagnostic interview data were collected from mothers, teachers, and fathers, and self-report information was obtained from youth between ages 10 and 14 years. First, convergent and discriminant validity were demonstrated for internalizing and externalizing multiagent constructs. Second, the depression-distortion hypothesis was examined, revealing a modest effect of maternal depression, leading to the inflation of reported son externalizing and daughter internalizing problems. The data suggest the need to consider multiple influences on parental perceptions of child behavior and psychopathology in research and clinical settings.

Depression, anxiety, and quality of life in siblings of children with intractable epilepsy

Thirty-seven siblings (aged 6-18) of children with intractable epilepsy were surveyed regarding their anxiety, depression, and quality of life, by both self-report (Revised Children's Manifest Anxiety Scale, RCMAS; Children's Depression Inventory, CDI; and Peds QL) and parental report (Child Behavior Checklist, CBCL). Completed forms were returned by 37 of 58 (64%) eligible families. No sibling had a score in the clinical range on the CDI, and only 2 of 37 (6%) scored in the clinical range on the RCMAS, a proportion similar to the normative population. In contrast, 25% were rated by their parents to have elevated Internalizing Behaviors scores on the CBCL. There was a trend for PedsQL scores to be lower than the normative mean. Comorbid behavior and attention problems in the child with epilepsy and sibling CDI and RCMAS scores correlated significantly with self-reported quality of life. However, other epilepsy, child, and family variables (income, parental education, family function, maternal depression) did not correlate. We conclude that siblings of children with intractable epilepsy are functioning well overall and have a good quality of life.

Toward a comprehensive model of antisocial development: A dynamic systems approach

The purpose of this article is to develop a preliminary comprehensive model of antisocial development based on dynamic systems principles. The model is built on the foundations of behavioral research on coercion theory. First, the authors focus on the principles of multistability, feedback, and nonlinear causality to reconceptualize real-time parent-child and peer processes. Second, they model the mechanisms by which these real-time processes give rise to negative developmental outcomes, which in turn feed back to determine real-time interactions. Third, they examine mechanisms of change and stability in early- and late-onset antisocial trajectories. Finally, novel clinical designs and predictions are introduced. The authors highlight new predictions and present studies that have tested aspects of the model

Duration and Developmental Timing of Poverty and Children's Cognitive and Social Development From Birth Through Third Grade

Relations of duration and developmental timing of poverty to children's development from birth to age 9 were examined by comparing children from families who were never poor, poor only during the child's infancy (0-3 years of age), poor only after infancy (4-9 years of age), and chronically poor. Chronically poor families provided lower quality childrearing environments, and children in these families showed lower cognitive performance and more behavior problems than did other children. Any experience of poverty was associated with less favorable family situations and child outcomes than never being poor. Being poor later tended to be more detrimental than early poverty. Mediational analyses indicated that poverty was linked to child outcomes in part through less positive parenting.

Maternal negative affect and perceptions of "problem children" in the family

This study investigates whether depressive tendencies or anger/hostility is associated with an increased propensity for a mother to target a particular child in the family as the "problem child." The 180 participants were drawn from a larger cohort of urban, low-income mothers and young children. Maternal data were gathered from measures of self-reported and observed maternal emotionality. Sibling unfavored status was assessed by maternal verbal comparison of siblings. Results were consistent in showing that neither maternal depressive nor hostile affect is, by itself, predictive of a tendency to single out one child as a "troublemaker." The significance of these results for causal models about differential parental treatment is discussed.

Behavior problems in young children: an analysis of cross-informant agreements and disagreements

This study examined (a) convergence between parents' and day care teachers' ratings of children's behavior problems, and (b) whether agreements and disagreements were associated with characteristics of the informant, context, or measures. Parents of 241, 2-4-year old children in day care centers serving low-income families completed measures of child behavior problems, parenting style, stress, depression, and self-efficacy. Teachers completed a measure of classroom behavior problems. There was a low correlation between parents' and teachers' ratings of child behavior (r=.17), and few children (2.5%) received high behavior problem scores from both parents and teachers. Cross-informant agreement on high behavior problem children was related to characteristics of the informants and home context. Implications for identifying children at risk are discussed.

Linked lives: stability and change in maternal circumstances and trajectories of antisocial behavior in children

Drawing on the notion of linked lives, this study examined the effects of stability and change in maternal circumstance on developmental trajectories of antisocial behavior in children 4 to 7 years of age. Using data from a national sample of young mothers and growth curve analysis, the study demonstrated that early maternal circumstances influences early antisocial behavior, whereas stability and change in these circumstances both exacerbate and ameliorate behavior problems. Of particular note, meaningful escape from poverty attenuates antisocial behavior whereas persistence in poverty or long-term movement into poverty intensifies such problems. These findings highlight the importance of structural context for parenting practices and the need to consider child development in light of dynamic and changing life-course fortunes of parents.

Association between clinically meaningful behavior problems and overweight in children

OBJECTIVE

To determine whether there is a relationship between clinically meaningful behavior problems and concurrent and future overweight in 8- to 11-year-old children.

METHODS

1998 National Longitudinal Survey of Youth interview data for 8- to 11-year-old children and their mothers were analyzed. A Behavior Problems Index score >90th percentile was considered clinically meaningful. Child overweight was defined as a body mass index (BMI) >or=95th percentile for age and sex. Multiple logistic regression was used to control for potential confounders (selected a priori): child's sex, race, use of behavior-modifying medication, history of academic retention, and hours of television per day; maternal obesity, smoking status, marital status, education, and depressive symptoms; family poverty status; and Home Observation for Measurement of the Environment-Short Form (HOME-SF) cognitive stimulation score. In an attempt to elucidate temporal sequence, a second analysis was conducted with a subsample of normal-weight children who became overweight between 1996 and 1998 while controlling for BMI z score in 1996.

RESULTS

The sample included 755 mother-child pairs. Of the potential confounding variables, race, maternal obesity, academic grade retention, maternal education, poverty status, and HOME-SF cognitive stimulation score acted as joint confounders, altering the relationship between behavior problems and overweight in the multiple logistic regression model. With these covariates in the final model, behavior problems were independently associated with concurrent child overweight (adjusted odds ratio: 2.95; 95% confidence interval: 1.34-6.49). The relationship was strengthened in the subsample of previously normal-weight children, with race, maternal obesity, HOME-SF cognitive stimulation score, and 1996 BMI z score acting as confounders (adjusted odds ratio: 5.23; 95% confidence interval: 1.37-19.9).

CONCLUSIONS

Clinically meaningful behavior problems in 8- to 11-year-old children were independently associated with an increased risk of concurrent overweight and becoming overweight in previously normal-weight children.

Nine years after child sexual abuse

OBJECTIVE

During 1988-1990, 103 children presented to Child Protection Units (CPU) at two children's hospitals in Sydney, Australia. Nine years later, the psychological adjustment of these young people (mean age=19.1 years, SD=3.4 years; range=14-25 years) was compared with that of non-abused young people of similar age and gender to assess group differences and examine potential risk factors.

METHOD

At intake, data on the nature of the index sexual abuse, demographics and the family environment were collected by clinicians. A comparison group, of similar age and gender, was selected from schools in the catchment area of the CPUs. Six years after presentation for the abuse, records of the statutory child protection authority were checked to determine any further notifications for abuse and/or neglect. Nine years after intake, 49 of the abused young people and 68 of the non-abused young people and/or their parents were interviewed and assessed.

RESULTS

The sexually abused young people performed more poorly than non-abused young people on psychometric tests of depression (p=.001), self-esteem (p<.001), anxiety (p<.001), behavior (Child Behavior Checklist: p=.01; Youth Self Report: p=.01; Young Adult Self Report: p<.001), and despair (p=.001). They were also more likely to have a history of bingeing (p=.002), self-inducing vomiting (p=.02), smoking cigarettes (p=.01), and using amphetamines (p=.002), ecstasy (p=.002) and cocaine (p=.004). Potential risk factors were in two groups, family and child. Family factors: family functioning, parental drug/alcohol problems, mother's sexual abuse history, mother's depression and socio-economic status. Child factors: despair and hopefulness, number of negative life events, ratings of their father's care, previous notifications for child sexual abuse and placements in out-of-home care by the statutory child protection authority. In the presence of other risk factors, child sexual abuse was a significant predictor of self-esteem, behavior and bingeing.

CONCLUSIONS

Rather than focusing only on the individual's child sexual abuse, treatment may also need to address the family's functioning and the individual's feelings of despair.

Relationships between maternal adult attachment security, child perceptions of maternal support, and maternal perceptions of child responses to sexual abuse

This study assessed the relationships between maternal adult attachment style, children's perceptions of maternal support following disclosure of sexual abuse, and maternal perceptions of children's behavioral and emotional responses to sexual abuse among African-American child sexual abuse victims aged 4 to 12 (n=96) and a comparison group of non-abused subjects (n=100). Mothers with insecure attachment styles reported significantly higher rates of internalizing behaviors in their sexually abused children than did securely attached mothers. Among mothers of non-abused children, those with insecure adult attachment styles reported significantly higher rates of externalizing behaviors shown by their children in comparison with mothers with a secure adult attachment style. Mothers with insecure adult attachment styles also reported higher rates of overall behavior problems in their non-abused children that approached statistical significance. Sexually abused children's perceptions of maternal support were not related to maternal attachment style nor to child functioning. Contrary to our prediction, mothers of sexually abused children did not show lower rates of secure attachments when compared to mothers of non-sexually abused children. Our findings indicate that fostering parent- child attachment is important in order to decrease the risk for behavior problems and symptomatology in sexually abused children.

Maternal variables related to sexually abused children's functioning

OBJECTIVE

The purpose of this study was to explore how mothers' developmental history and current functioning affects their sexually abused children's functioning and recovery.

METHOD

A sample of 67 African-American mothers and their sexually abused children participated in this study. Interviews and a range of adult and child measures were administered in order to assess maternal developmental history and current functioning, and child functioning.

RESULTS

Mothers' past experiences as children were associated with their children's behavior and general functioning following the sexual abuse. Mothers who experienced more discontinuity of childhood care, who were sexually abused as children, and/or had more problems in their family of origin had children who showed poorer functioning and more behavioral symptomatology. In addition, mothers who currently were experiencing more trauma symptomatology, reported substance abuse, and/or were less able to provide support to their children, had children with more behavior problems and poorer functioning.

CONCLUSIONS

The findings from this study point to the impact of mothers' developmental history and current functioning upon the symptomatology of their sexually abused children.

Psychosocial adjustment in children of mothers with breast cancer

Thirty-five children of 28 mothers diagnosed with breast cancer during the previous year were compared to 34 children of 24 mothers with recent benign breast biopsies. Mothers and children, ages 8-16, completed questionnaires about mood, behavior problems and social functioning to assess whether children of mothers with breast cancer were at increased risk for adjustment problems. Significant differences were not found between children in the breast cancer group and the comparison group on any of the measures, even though mothers with breast cancer reported more psychological distress than mothers with benign biopsies. In addition, children in both groups were functioning better than normative samples on some adjustment measures. Variables measuring the mother's illness and treatment were not significantly related to children's adjustment in the breast cancer group. Findings suggested that some adolescents whose mothers had breast cancer did better in social and academic activities when their mothers were more distressed, while adolescents whose mothers had benign biopsies did less well when their mothers were distressed. The study's small sample size limits conclusions that can be drawn; however, clinical and research implications are discussed, given other reports that some children of parents with cancer may experience adjustment problems.

Mother and child perceptions of child functioning: relationship to maternal distress

The relationship between maternal distress and mother's reports of psychosocial problems in their children has been well-documented. However, relatively little research has investigated the relationship between maternal and family distress and young children's perception of their own functioning. Using a brief questionnaire designed for use with children, data were collected from 166 mothers and their children aged 5-12 years. Children provided information about their own daily functioning, and mothers provided information about their own, their child's, and their family's psychosocial functioning. Findings indicated that while children generally agreed with the reports of their mothers, children of distressed mothers self-reported better daily functioning than their mothers did. Distressed mothers tended globally to report negatively about themselves, their child, and their family. The present findings suggest that when assessing mothers or children, the reports of children should be considered as well as the reports of mothers.

Predictors of child psychological changes during family-based treatment for obesity

OBJECTIVE

To explore the influence of 1-year changes in child obesity and maternal psychopathology on changes in child psychological problems.

DESIGN

Hierarchical regression models were used to predict child psychological change, with demographic variables, maternal psychological change, and child percentage overweight change as predictors.

SETTING

Pediatric obesity research clinic.

PARTICIPANTS

Clinic sample of 116 obese 8- to 12-year-old children and their mothers.

INTERVENTIONS

Family-based behavioral weight-control program.

MAIN OUTCOME MEASURES

Child psychopathology was assessed via mother-reported Child Behavior Checklists and maternal psychopathology was determined by standardizing scores on the Cornell Medical Index and the Symptoms Checklist-90-Revised.

RESULTS

Significant improvements were observed in child percentage overweight (-20.1% overweight), and child and maternal psychopathology. Improved maternal psychopathology accounted for a significant amount of variance in improvements in the Child Behavior Checklist total Problems Scale and internalizing and externalizing problems subscales. Decreased obesity accounted for a significant amount of variance in improvements in the Total Competence scale and, somatic complaints, social problems and social competence subscales of the Child Behavior Checklist. Significant interactions of child obesity change by sex were found for Total Problems and externalizing scores. The interactions were due to girls with greater obesity reduction showing greater improvement in Total Problems, whereas boys with greater obesity reduction showed less improvement in externalizing problems.

CONCLUSIONS

These results highlight the multidimensional nature of psychosocial functioning in obese children and call attention to multiple avenues for intervention to improve their psychosocial functioning.

Methodological issues in assessing resilience in maltreated children

OBJECTIVE

Efforts to assess resilience in maltreated children reveal methodological difficulties in developing operational definitions of resilience. This paper discusses six methodological issues: (1) distinguishing between resilience and factors promoting or reducing resilience; (2) choosing sources of measures; (3) determining how many sources and measures to use; (4) selecting scoring criteria to indicate resilience; (5) determining when to measure resilience; and (6) examining the stability of resilience over time.

CONCLUSIONS

Understanding resilience in maltreated children is important for developing ways to promote competence in more vulnerable maltreated children. Although the classification of children as resilient depends on how resilience is defined, there is no consensus regarding operational definitions of resilience. By focusing more attention on the issue of resilience, research on maltreated children can help resolve methodological difficulties in defining and measuring the concept.

[Efficacy of a treatment program for sexually abused children]

OBJECTIVE

An evaluation study was conducted in order to evaluate the impact of the treatment program for sexually abused children.

METHOD

Forty-one (41) children (aged 6-17 years), victims of a sexual abuse by a family member, were assessed at pre- and post-treatment (16 months following the pre-test). The evolution of children's psychological well-being was measured by the Children's Depression Inventory (CDI), the Picturial Scale of Perceived Competence and Acceptance for Young Children (PSPCA), the Children's Nowicki-Strickland Internal-External control scale (CNS-IE), the Children's Action Tendency Scale (CATS), the Revised Children's Manifest Anxiety Scale (RCMAS), and the Pediatric Behavior Scale (PBS). A hierarchical multiple regression analysis was used to assess the strength of the relationship between the level of participation in both individual (including dyadic and family therapy) and group therapy and the evolution of Ss' psychological well-being.

RESULTS

Results indicate that the child's mental health was generally positively related to the level of participation in individual therapy but not related or negatively related with the level of participation in group sessions except for the PBS.

CONCLUSIONS

These results indicate the need: (a) to consider the adoption of a dose measurement in the appreciation of the therapeutic impact; (b) to have a better grasp of the nature and the effects of specific therapeutic activities included in a program; (c) to have a better understanding of the disparities observed between parents' and children's evaluation of the psychological status of the child.

Association of maternal psychological functioning to pathology in child sexual abuse victims

The purpose of this study was to assess the psychological impact of disclosure of sexual abuse on child victims and their mothers and evaluate whether there was an association between maternal distress and report of child behavioral and psychological problems. Data on child psychological and behavioral problems and maternal psychological functioning were collected at the time of disclosure of sexual abuse and 9 months later for 49 subjects. The study showed the heterogeneity and severity of problems among victims and their mothers at baseline. These problems persisted almost a year later. Maternal distress was strongly correlated with the mothers' assessments of child functioning and was less strongly associated with the children's own assessments of their status. Because the mothers in this study reported high levels of persistent distress for themselves and their children, comprehensive intervention with the family may be an efficient route to child recovery after disclosure of sexual abuse.

Sleep problems in children of affectively ill mothers

The objective of the study was to determine whether the frequency and severity of sleep problems were greater in children of affectively ill mothers than in children of control mothers. Sleep problems were studied in children of mothers with a diagnosis of unipolar (N = 38) and bipolar (N = 23) affective illness and children of mothers with no current or past psychiatric diagnosis (N = 24). Mothers' reports on the Child Behavior Checklist (CBCL) were obtained three times, 4 years apart, on sibling pairs (ages 1.5-3.5 and 5-8 years, respectively, at first assessment). In addition, on the third assessment, the Diagnostic Interview for Children and Adolescents was filled out by mothers and children. In both siblings, sleep problems, as assessed through the CBCL, were more frequent and severe in children of affectively ill mothers. In younger siblings, the persistence of sleep problems was more frequent in children of affectively ill mothers. Co-occurrence of sleep problems among siblings was more frequent in children of affectively ill mothers than in those of control mothers.

Sexually abused children 5 years after presentation: a case-control study

OBJECTIVE

A total of 68 sexually abused children and their nonoffending parents were reassessed 5 years after presentation and were compared with a cohort of children of similar age and sex who were not known to have been abused.

METHOD

Outcome measures were behavior, depression, self-esteem, anxiety, eating problems, drug use, suicide attempts, self-injury, running away, criminal activity, and attributional style. Recent life events, demographics, family functioning, and mothers' mental health were taken into account when examining outcome.

RESULTS

Although the abused children had experienced more negative life events, were from lower socioeconomic groups, had more changes in parent figures, and had mothers who were more psychologically distressed, multiple regression analysis showed that after allowing for these and other demographic factors, there were still significant differences between the groups after the 5 years. The abused children displayed more disturbed behavior, had lower self-esteem, were more depressed or unhappy, and were more anxious than controls. Sexually abused children had significantly higher levels of bingeing, self-injury, and suicide attempts.

CONCLUSIONS

It is clear that many children who are sexually abused have ongoing problems. Their ongoing problems may be indicative of false beliefs about themselves and the sexual abuse experience.

Does psychiatric history bias mothers' reports? An application of a new analytic approach

OBJECTIVE

To evaluate whether mothers' psychiatric history biases reports of their children's behavior problems, mothers' and teachers' reports of children's behavior problems were compared using a recently developed statistical approach.

METHOD

Child Behavior Checklists and Teacher's Report Forms were completed by mothers and teachers, respectively, about 801 six-year-old children. Mother's history of major depression, anxiety disorders, and substance use disorder was assessed by using the National Institute of Mental Health Diagnostic Interview Schedule. Generalized estimating equations were used for data analysis.

RESULTS

According to both teachers and mothers, maternal history of major depression was associated with more internalizing problems; the association was significantly stronger when mothers were the informants. Mothers with history of any psychiatric disorder reported more externalizing problems in their children than expected, whereas teachers' reports of externalizing behaviors were unrelated to maternal psychiatric history. These findings could not be explained by variations in children's behaviors across settings.

CONCLUSION

The generalized estimating equation models enabled simultaneous examination of whether children of depressed mothers have excess behavior problems and whether depressed mothers overreport behavior problems in their children. The results indicate that children of depressed mothers have more internalizing problems. In addition, depressed mothers overstate and overgeneralize their offspring's behavior problems. This study broadens the concerns with reporting bias beyond maternal depression to include other psychiatric problems. The results emphasize the potential for bias in family history studies that rely on informants.

Acceptability of the Conners Parent Rating Scale and Child Behavior Checklist to Dakotan/Lakotan parents

OBJECTIVE

The objective of this pilot study was to determine how Dakotan/Lakotan parents view the Conners Parent Rating Scale (CPRS) and Child Behavior Checklist (CBCL).

METHOD

Using a focus group methodology, four discussion groups were held in different sites across South Dakota where the CPRS and CBCL were in clinical use.

RESULTS

Only two questions on each form were incomprehensible to these Dakotan/Lakotan parents. Other questions were hard to answer because certain questions contained implicit dominant cultural values that did not take into account Dakotan/Lakotan cultural values or traditions, or the questions were hard to answer because Dakotan/Lakotan believed their responses could or would be misunderstood by members of the dominant culture who did not understand Dakotan/Lakotan style or customs.

CONCLUSIONS

The CPRS and CBCL were generally acceptable to Dakotan/Lakotan parents. Clinicians could make several statements to Native parents that would improve cultural acceptability.

The association of maternal psychopathology and family socioeconomic status with psychological problems in obese children

In an earlier study we found parental psychiatric symptoms to be a better correlate of behavioral problems in obese children than either child or parental obesity. This study sought to extend this research by assessing the association of general maternal distress, specific maternal psychopathology, family socioeconomic status and child obesity with the psychological problems of 152 children seeking treatment for obesity in two cohorts. Child psychological problems were measured using the Child Behavior Checklist/4-18 (CBCL) in each cohort. In sample 1 maternal general psychiatric symptoms were measured using the Cornell Medical Index (psychiatric subscales) and the Inventory of Interpersonal Problems whereas specific psychopathology was assessed with the Beck Depression Inventory and the Bulimia Test. In sample 2 the Symptom Checklist-90 and Binge Eating Scale provided general and specific measures of psychopathology. In the combined sample, 58% percent of the boys and 44% of the girls met criteria on at least one CBCL behavioral problem scale, with Social Problems the most prevalent problem in both boys and girls. For both samples, child obesity did not account for any variance in child psychosocial problems beyond that accounted for by maternal psychopathology and family SES. Family SES accounted for a significant increment in variance in child behavioral problems in only two scales. This study systematically replicates previous research, adding support for a broader conceptualization of factors that influence psychological problems in obese treatment-seeking children than one which focuses on child obesity.

Mother and teacher assessments of behavior problems in abused children

OBJECTIVE

Mother and teacher ratings of behavior problems in abused and nonabused children were compared. The extent to which ratings were related to maternal depressive symptoms was examined.

METHOD

The sample for this report consists of 172 elementary school-age abused children and a matched comparison group of 155 nonabused children. Maternal and teacher ratings of child behavior were obtained with the parent and teacher versions of the Achenbach Child Behavior Checklist. Maternal depressive symptomatology was assessed with the CES-Depression Scale.

RESULTS

Mothers and teachers rated abused children, both boys and girls, as having greater behavior problems than nonabused children, with abused boys having more problems than abused girls. Regardless of abuse status, there were no significant differences by rater. Maternal depressive symptomatology had independent effects on maternal ratings but was not related to teacher ratings. The combination of abuse and maternal depressed mood resulted in the greatest problems for children. Both raters reported greater problems in the clinical range for abused boys than for nonabused boys. Few differences were noted between abused and nonabused girls for clinical problems.

CONCLUSIONS

Intervention strategies for abused children must address their behavioral problems and must consider the extent of depressive symptoms in the children's mothers.