Preschool behavior can predict future psychiatric disorders

Maternal pre-pregnancy weight status and gestational weight gain in association with child behavior: The mediating role of prenatal systemic inflammation

BACKGROUND AND AIMS

Maternal pre-pregnancy obesity and excessive gestational weight gain (EGWG) may predispose children to behavioral problems through increased prenatal inflammation. We investigated the association between maternal body mass index (BMI) and gestational weight gain (GWG), and child behavioral problems (primary aim), and the mediating role of prenatal inflammation (secondary aim).

METHODS

We used self-reported pre-pregnancy BMI and estimated-GWG data (N = 1137) from a longitudinal cohort study. Maternal serum C-reactive protein (CRP) was measured in the 3rd-trimester. Parent-reported Child Behavior Checklist (CBCL) was used to assess child internalizing and externalizing behaviors at 3-years-of-age. We used analysis of covariance (ANCOVA), multiple linear regression, and mediation analyses for data analysis.

RESULTS

Maternal obesity (F = 21.98, df 3836), EGWG (F = 6.53, df 2764), and their combination (F = 18.51, df 3764) were associated with the 3rd trimester CRP, but not child behavior in the whole sample. Maternal underweight was associated with withdrawal problems in all children (β = 0.56, 95%CI, 0.11,1.00) and aggressive behaviors in female children (β = 2.59, 95%CI, 0.28,4.91). Obesity had a significant association with externalizing behaviors in female children after controlling for maternal CRP (β = 3.72, 95%CI, 0.12,7.32). Both inadequate and EGWG were associated with somatic complaints in male children (β = 0.50, 95%CI, 0.05,0.95; β = 0.36, 95%CI, 0.01,0.71, respectively). Combined obesity/EGWG was associated with externalizing (β = 6.12, 95%CI, 0.53,11.70) and aggressive (β = 4.23, 95%CI, 0.90,7.56) behaviors in female children. We found no significant effects through CRP.

CONCLUSIONS

Maternal pre-pregnancy BMI and GWG showed sex-specific associations with child behavioral problems. Prenatal CRP, although increased in obesity and EGWG, did not mediate these associations.

Behavioral consequences of mild traumatic brain injury in preschoolers

BACKGROUND

Pediatric traumatic brain injury (TBI) is a leading cause of long-term disability in children and adolescents worldwide. Amongst the wide array of consequences known to occur after pediatric TBI, behavioral impairments are among the most widespread and may particularly affect children who sustain injury early in the course of development. The aim of this study was to investigate the presence of internalizing and externalizing behavioral problems 6 months after preschool (i.e. 18-60 months old) mild TBI.

METHODS

This work is part of a prospective, longitudinal cohort study of preschool TBI. Participants (N = 229) were recruited to one of three groups: children with mild TBI, typically developing children and orthopedic injured (OI) children. Mothers of children in all three groups completed the Child Behavior Checklist as a measure of behavioral outcomes 6-month post-injury. Demographics, injury-related characteristics, level of parental distress, and estimates of pre-injury behavioral problems were also documented.

RESULTS

The three groups did not differ on baseline characteristics (e.g. demographics and pre-injury behavioral problems for the mild TBI and OI groups) and level of parental distress. Mothers' ratings of internalizing and externalizing behaviors were higher in the mild TBI group compared with the two control groups. Pre-injury behavioral problems and maternal distress were found to be significant predictors of outcome.

CONCLUSION

Our results show that even in its mildest form, preschool TBI may cause disruption to the immature brain serious enough to result in behavioral changes, which persist for several months post-injury.

Temperament, Stress and Family Factors in Behavioural Adjustment of 3-5-Year-Old Children

In a longitudinal study, various aspects of the pre-schooler and his/her environment were assessed to delineate those factors most predictive of behavioural adjustment at 3-4 years of age, and again 12 months later. Factor analysis and a series of backwards stepwise multiple regression analyses facilitated the selection of variables to be included in a causal model that assessed predictors of behavioural adjustment in 3-4 and 4-5-year olds. A "stress resilience" model of temperamental influence on behavioural functioning was used in the construction of the causal model. Path analysis suggested that temperamental characteristics were most strongly causally related to children's overall behavioural adjustment, and could protect children from the effects of maladjustment in the parental subsystem. According to the path model, the direct effect of parental maladjustment on pre-schoolers' behavioural adjustment was outweighed by its indirect effects, particularly at follow-up. The potential contaminating influence of parental maladjustment on their perceptions of children's temperament and behaviour, as well as the content and construct overlap between temperament and behavioural measures, was considered.

The North American Perspective On Attention Deficit Hyperactivity Disorder

The purpose of the present paper is to (1) provide an overview of the nature of attention-deficit hyperactivity disorder (ADHD) as it seems to be viewed by North American clinicians and clinical scientists; (2) describe its diagnostic criteria as they are applied in that region; (3) discuss the prevalence of ADHD in the region; and (4) briefly present a new theoretical model of the authors emerging from that North American perspective. Some of the critical issues related to these matters will be raised along the way. Given the thousands of scientific papers on this topic, however, an overview of these various topics is all that space here can afford. Readers wishing a more thorough treatment of these topics as well as those pertaining to history, developmental courses, associated risks, assessment, and treatments for ADHD are directed to other writings by the author (Barkley, 1990).

Psycho-behavioral changes in children with type 1 diabetes mellitus

BACKGROUND

Type 1 diabetes mellitus (T1DM) is the most common type of diabetes in children. This study aimed to investigate psycho-behavioral changes in Chinese children with T1DM and to provide some advices for nurses, parents and other persons.

METHODS

Forty-five patients with T1DM (26 boys and 19 girls with a mean age of 10.40±3.01 years) were enrolled. According to the glycosylated hemoglobin levels recommended by the American Diabetes Association, the patients were subdivided into a well-controlled group and a poorly-controlled group. Fifty-three healthy children served as a control group. Psycho-behavioral changes were investigated by using Achenbach's Child Behavior Check List.

RESULTS

Compared with the control group, the patients with T1DM had significantly higher mean scores for withdrawal, anxiety/depression, attention problems, delinquent behavior, aggressive behavior, externalizing problems, and internalizing problems (P<0.017). Moreover, the mean scores for somatic complaints in the poorly-controlled subgroup were significantly higher than those in the well-controlled subgroup (t=3.582, P=0.001). Compared with the control group, the well-controlled subgroup had higher scores for withdrawal, anxiety/depression, and internalizing problems (P<0.017). But the poorly-controlled subgroup had higher scores for withdrawal, somatic complaint, anxiety/depression, delinquent behavior, aggressive behavior, externalizing and internalizing problems (P<0.017).

CONCLUSIONS

Children with T1DM may have some psycho-behavioral problems. Timely nursing interventions must be conducted to solve these problems.

Attachment security in preschoolers with and without externalizing behavior problems: A replication

This study attempted to replicate previous findings that indicated that preschool-aged children with significant externalizing problems are more likely to have insecure attachment relations than nonproblem peers (Speltz, Greenberg, & DeKlyen, 1990). Fifty children (ages 3–6) and their mothers participated; 25 referred to a child psychiatry clinic for one of the DSM-IIIR Disruptive Behavior Disorders, and 25 matched comparisons without externalizing behavior problems. Attachment was measured at the time of referral using two separation and reunion sequences in a clinic context. We found that 80% of the clinic-referred children were classified as insecure, whereas only 28% of the comparisons were so classified (p <.001). Further, a high percentage of clinic insecure children showed a controlling pattern of attachment. Thus, the present study, with improved methodological rigor, provided an almost exact replication to previous results. The discussion focuses on what contribution attachment research can provide to a developmental psychopathology perspective on early externalizing disorders.

Early behavior problems: Pathways to mental disorders in adolescence

From teachers' rating in kindergarten through third grade, mutually exclusive groups of internalized, externalized, and mixed behavior problems were examined as pathways to three groups of psychiatric diagnosis in later adolescence: depression/anxiety, conduct/oppositional defiant, and other disorders. In looking both forward and backwards, the relation between behavior problems in the early school years, regardless of type, and psychopathology in adolescence, regardless of diagnosis, was very strong. The relations between type of early problems and specific outcomes were weak. The findings provided support for both the constructs of multifinality and equifinality; however the nature of the pathways differed somewhat by disorder. There was a substantial amount of multifinality (dispersion of outcomes) for the early internalizing pathway. There was less multifinality for the externalizing pathway, in that there was greater correspondence between early externalizing and later antisocial outcomes than for the internalizing pathway and depressed/anxious outcomes.

Attachment in preschoolers with disruptive behavior: A comparison of clinic-referred and nonproblem children

This study tested the hypothesis that preschool-aged children with significant externalizing behavior problems are more likely to have insecure attachment relationships than nonproblem peers, as measured by separation/ reunion behavior at the time of clinic referral. Fifty children (ages 3–6) and their mothers participated: 25 referred to a child psychiatry clinic for one of the DSM-III-R Disruptive Behavior Disorders, and 25 matched comparison children without behavior problems. Using two new attachment coding systems for children of this age, we found that 84% of the children in the clinic group were classified as insecure, whereas only 28% of the comparison group were so classified (p <.001). Clinic children were also found more frequently to protest their mother's departure and to search for her more often during the separation. The implications of these results for the validity of separation/reunion behavior as an index of attachment at this age are discussed, as well as the methodological and conceptual problems that complicate our study of the link between attachment and behavior disorder.

Mother-child joint activity and behaviour problems of pre-school children

BACKGROUND

Behaviour problems are common among pre-school children, and a substantial proportion persist, causing significant burden to the family, schools and health services. Relatively little research has addressed the effects of positive parenting on behaviour disorder in pre-school children, particularly in larger population-based studies.

METHOD

A cross-sectional postal survey of a representative, population-based sample of 800 mothers of 3 1/2-year-old children living in an outer London Borough was carried out to assess the association between mother-child joint activity and behaviour problems of pre-school children. The response rate was 70%.

RESULTS

Lower levels of mother-child joint activity remained independently associated with behaviour problems of pre-school children both on a binary and a continuous scale after adjusting for a wide range of household, maternal and child circumstances. The association between low levels of mother-child joint activities and behaviour problems of the children was stronger in the presence of social problems in the family.

CONCLUSION

Possible causal pathways and directions for future research and intervention are discussed.

Behavior in term, small for gestational age preschoolers

AIMS

To evaluate whether being born small for gestational age (SGA) was associated with an increased frequency of preschool behavioral problems.

STUDY DESIGN

Follow-up study at 5 years of age.

SUBJECTS

A population based cohort of 318 term infants who were SGA, defined as having a birthweight less than the 15th percentile for gestational age, and without major handicap such as cerebral palsy or mental retardation, and a random control sample of 307 appropriate for gestational age (AGA) infants.

OUTCOME MEASURES

The Personality Inventory for Children and the Yale Children's Inventory (completed by the mothers), and child behavior during psychometric testing.

RESULTS

Behavior problems was not more common among the SGA children. The results were not confounded by a wide range of parental demographic and child rearing factors, including maternal non-verbal problem solving abilities, child rearing style, and maternal psychological distress. However, the parental factors explained 13% of the variance in a summary score of child behavior compared to 1% explained by SGA vs. AGA status. The SGA children were not more sensitive to the negative impacts of parental risk factors than AGA controls. The study does not address the outcome of severely growth-retarded SGA infants.

CONCLUSION

Being born moderately SGA is not a significant risk factor for preschool behavior problems.

Turning primary care providers' attention to child behavior: a review of the literature

Twenty-five years ago, writers first drew the nation's attention to the "new morbidities"--problems that were biosocial or developmental in nature and were induced or complicated by social or environmental factors. The American Academy of Pediatrics responded by urging primary care providers to spend more time counseling parents on behavioral issues. Recent violent episodes in schools have renewed concern and prompted child health advocates to ask how well primary care providers are doing in attending to problematic childhood behavior. A review of the literature was conducted to examine the role the primary care provider plays in attending to childhood behavior.

Attention-deficit/hyperactivity disorder in preschoolers. Does it exist and should we treat it?

The diagnosis of ADHD in preschool-aged children is difficult. High activity level, impulsivity, and short attention span--to a degree--are age-appropriate characteristics of normal preschool-aged children. However, excessive levels of these characteristics impede successful socialization, optimal learning, and positive parent-child interaction. Environmental stressors, inadequate parenting skills, and other diagnoses such as oppositional defiant, posttraumatic stress, or adjustment disorders can mimic ADHD. Although labeling may be necessary to obtain services, the emphasis should be placed on symptom resolution, given the uncertainties of diagnostic accuracy in this age group. Deferring a specific diagnosis of ADHD until confounding issues are clarified should be considered. The evaluation of serious behavior problems in young children must include a comprehensive consideration of environmental, health, cognitive, educational, and behavioral interactions. Both assessment and intervention should focus on the interactions between the child and his or her environment to determine how they facilitate or hinder adaptive integration as both the child and surroundings change and evolve. Treatment invariably necessitates involvement of a child and family psychotherapist or counselor to address behavior management strategies as well as family dynamics, parental psychopathology, or life stress. Parents must understand that counseling is an essential component of treatment and that they must be active participants. Psychopharmacologic intervention may be appropriate in some instances, although conventional wisdom suggests caution in young children, given the limited information about safety and efficacy of many agents, especially in children younger than 3 years old. Stimulants appear to be safe in older preschool-aged children. Children started on medication should be monitored closely for both positive and negative effects. A double-blinded, placebo-controlled trial of medication is warranted in equivocal situations.

Factor structure and subtest differences on the Preschool Behavior Questionnaire in a Latino, African-American, Euro-American, and Asian preschool population

This study examined the factor structure of the Preschool Behavior Questionnaire in a sample of African-American, Euro-American, Asian, and Hispanic children. The sample consisted of 304 children (141 boys, 163 girls) 3- and 4-yr.-old and enrolled in Head Start. A principal component analysis with a varimax rotation was conducted and two- and three-factor solutions were extracted. A two-factor solution produced a clear interpretive structure representing Fowler and Park's 1979 Aggressive-Hyperactive-Distractible and Anxious-Fearful factors. Even though a three-factor solution was statistically appropriate, extracting more than two factors yielded dimensions difficult to interpret. Examination of subscale differences among ethnic groups indicated significant group effect for ethnicity. Further examination showed that Euro-American children are rated significantly higher on the Anxious subtest than Latino, African-American, and Asian children, but there were no other subscale differences. Clinical and research implications are discussed.

Maternal depressive symptoms and homeless children's mental health: risk and resiliency

Homelessness places children at risk for mental health problems. Maternal depression may influence child outcomes through its effects on the mother-child relationship. This study examined the relationship between maternal depressive symptoms and child mental health in a sample of homeless mothers and their preschool children. The relationship between maternal depressive symptoms and child behavior problems was not significant. The data suggest that mental health services for homeless mothers and their young children are needed. However, 70% of the children in this sample had no behavior problems. Their adaptation reflects resilience to extraordinary stressors and provides a unique opportunity to understand child resiliency.

Effects of age of entry, day-care quality, and family characteristics on preschool behavior

Teachers evaluated 155 4-5-year-old children attending Montréal day-care centers of excellent (N = 51), average (N = 60), or low (N = 44) quality using behavioral scales. Age of entry to day-care was also considered. Center quality was assessed by two observers using the Early Childhood Environment Rating Scale. Results point to the positive effects of longer exposure to high-quality group day-care (increased interest-participation), and the negative effects of longer exposure to low-quality centers (increased anger-defiance). Positive or negative family characteristics contributed further to these effects.

DSM-III-R disorders in preschool children from low-income families

OBJECTIVE

To generate rates of DSM-III-R disorders in a sample of preschool children from low-income families, examine impairment ratings for preschool children meeting criteria for DSM-III-R disorders, and compare rates of psychopathology using DSM-III-R criteria with rates generated by the Child Behavior Checklist (CBCL).

METHOD

As part of an ongoing longitudinal study of 104 mother-child dyads from low-income families, data were gathered when children were 5 years of age. DSM-III-R disorders were diagnosed through the administration of the Schedule for Affective Disorders and Schizophrenia for School-Age Children to the mothers, and mothers competed the CBCL.

RESULTS

Rates of DSM-III-R disorders among preschool children from low-income families were higher than those reported in community samples, but comparable with rates for low-income school-age children and adolescents. Children meeting criteria for DSM-III-R disorders were rated as significantly impaired. The prevalence of behavioral and emotional problems was similar by both DSM-III-R criteria and the CBCL. There was some evidence, however, that the two systems identified different children.

CONCLUSIONS

DSM-III-R criteria appear to adequately identify preschool children with serious behavioral and emotional problems. Longitudinal studies are needed to explore further the relative utility of the DSM and CBCL in the identification of psychopathology in preschool children.

Behavioral problems in low-birthweight preschoolers

Preschool behavior of a population-based sample of 144 5-year-old children with birthweights less than 2000g (LBW) was compared with a random sample of 163 normal-birthweight term controls. The Personality Inventory for Children and the Yale Children's Inventory were completed by the mothers, and child behavior during psychometric testing was assessed. Nineteen per cent of the LBW children compared to 4% of controls had behavioral problems as defined by abnormal scores on more than three behavioral measures. The LBW children were more often socially insecure, anxious and difficult to manage, but inattention and hyperactivity were not prominent. The LBW children were not more sensitive to the negative impact of parental risk factors than normal-birthweight children.

Pattern of preschool behavior problems in New Zealand, using the Behavior Check List

OBJECTIVE

The main aim of the study was to identify the pattern of behaviour problems in preschool children to enable early recognition and intervention.

METHODOLOGY

Three hundred and twenty children, in eight randomly selected preschool centres, aged between 2.5 and 5 years, were included in the study. Parents completed the Behaviour Check List (BCL),a screening measure for preschool behaviour problems.

RESULTS

Dependency, temper tantrums, and being difficult to manage were the commonly rated symptoms when moderate-severe problems were examined. Developmental problems decreased with increasing age, while relationship problems and worries that were cognitively mediated worsened. There were no major differences in the patterns between boys and girls. On cross-cultural comparison, parents in New Zealand rated their children lower on the BCL compared to those in the UK. Factor analysis of the BCL yielded seven factors. The two main factors 'predominantly conduct' and 'predominantly emotional' consisted of a mixture of conduct (difficulty in managing, temper tantrums, sibling rivalry) and emotional (unhappy mood, worry, fears) problems. The other five factors were related to developmental problems.

CONCLUSIONS

These results help clinicians identify the emerging pattern of preschool behaviour problems that change with increasing age and vary with differing cultures. Categorical presentation of preschool behaviour problems support the view that they should be included in a classification system.

Help-seeking for behavior problems by parents of preschool children: a community study

OBJECTIVE

To identify barriers to seeking help for preschool behavior problems and understand the pattern of service utilization.

METHOD

Altogether, 320 preschool children from eight preschool centers were studied using a two-stage design. After the initial screening, a more detailed assessment was carried out in the second stage involving semistructured interviews with parents and children. Parents also completed a service utilization questionnaire during the first stage and General Health Questionnaire, Family Assessment Device, and life events questions during the second stage.

RESULTS

Only 19% of those with preschool behavior disorder crossed all the filters in reaching for help. The most common perceived barriers to help-seeking were that problems would get better by themselves or that parents should be strong enough to handle them. The major blocks to help-seeking were at two levels, in parents recognizing the presence of a problem and in overcoming the perceived barriers by the parents. Parents sought help from the informal agencies more often than from the formal. Help was sought significantly less often by those who had parental separation, low income, or multiple adversities, all of which were known to be significantly associated with behavior disorder.

CONCLUSION

These findings indicate the need to educate and influence the parents' attitude to help-seeking, target those at risk to develop behavior disorder, and develop better consultation-liaison service with the informal agencies.

A community study of preschool behaviour disorder in New Zealand

A two stage epidemiological study of 320 children aged between 2.5 and 5 years of age, from eight randomly selected preschool centres, was performed in order (1) to test the psychometrics of the Behaviour Check List (BCL), a parent report instrument for preschool children, (2) to estimate the prevalence, and (3) to describe the correlates of preschool behaviour disorder. After the initial screening using the BCL, the Hyperactivity Scale (HAS) and the Internalising Disorder Scale (IDS), parents were interviewed using the Behaviour Screening Questionnaire (BSQ); the children were examined using the Rutter and Graham's interview. Data was also collected on family functioning, maternal mental health, social adversity, development, physical health and perinatal history. The BCL was found to be a reliable and valid screening measure. A cut off point of 8+ was established for New Zealand preschoolers; this is lower than that in the UK sample, illustrating the importance of retesting the instruments in a different culture. The prevalence rate of behaviour problems based on clinical diagnosis was 22.5%. Results of logistic regression analysis showed that poor family functioning, poor maternal mental health and parental separation were associated significantly with behaviour disorder. This study emphasises the need to identify preschool behaviour disorder and associated risk factors to enable an early intervention.

Mental and somatic health and social adjustment in ordinary school children during childhood and adolescence related to central nervous functions as expressed by a complex reaction time

A cohort of ordinary Swedish children were followed up from school entry through childhood and adolescence and checked retrospectively from birth to the age of 6 years regarding psychiatric and physical health and contact with the social welfare authorities. The children were allocated to different risk groups at age 7 on the basis of their psycho-physical development expressed as complex reaction time (CRT). It was previously shown that many of the slow CRT children have problems in psychomotor and language development at school, and that many leave compulsory school with poor achievements in Swedish and gymnastics as continuing signs of their developmental delay. This study shows that slow CRT children have an increased prevalence of child psychiatric problems. At an early age there were symptoms of aggression, hyperactivity and withdrawal in conjunction with developmental delay. During adolescence, depression, maladjustment and psycho-somatic disorders were prominent features, often in association with developmental delay, dyslexia and poor motoric skill. These children could have a disadvantage at school and in society and they felt themselves "handicapped" and were stressed by feelings of limited future possibilities. In adolescence, many of them were in need of help, especially financial aid from the social welfare services. The findings stress that a slow cognitive processing ability seen as a slow CRT must be considered a handicap of importance and a risk-factor in the society of today, with primary or secondary psychic and social manifestations often in a multifactorial setting of biological co-morbidity and family problems. In contrast, an advanced CNS development with a fast CRT may be seen as a protective factor.

Psychosocial risks for major depression in late adolescence: a longitudinal community study

OBJECTIVE

An ongoing 14-year longitudinal study examined psychosocial antecedents of major depression in late adolescence in a community population.

METHOD

Subjects were 385 adolescents followed between the ages of 5 and 18 years. Early health, familial, behavior, academic, and environmental risks for major depression were identified using data collected at ages 5, 9, 15, and 18 years. At age 18, a lifetime diagnosis of major depression was assessed using the NIMH Diagnostic Interview Schedule (DIS-III-R).

RESULTS

For males, neonatal health problems, dependence problems at age 5 years, perceived unpopularity and poorer perceptions of their role in the family at age 9 years, remarriage of a parent, early family discord, and anxiety at age 15 years significantly increased the risk of developing major depression. Females with major depression, compared with nondepressed females, had older parents and came from larger families, and at age 9 years had greater perceived unpopularity and anxiety, lower self-esteem, and poorer perceptions of their role in the family. Depressed females also reported more stressful life events, including death of parent and pregnancy.

CONCLUSIONS

Underscoring the importance of early psychosocial factors in the later development of major depression and pointing to specific risks, our findings can aid in developing strategies for prevention and early intervention.

Enhancing the development of low-birthweight, premature infants: changes in cognition and behavior over the first three years

The Infant Health and Development Program is a randomized clinical trial to test the efficacy of educational and family support services and pediatric follow-up offered in the first 3 years of life on reducing the incidence of developmental delay in low-birthweight (LBW), preterm infants in 8 clinical sites (N = 985). Effects of the intervention on cognitive and behavior problem scores over the 3 years are examined. Significant intervention effects were seen on cognitive scores at 24 and 36 but not 12 months of age; effect sizes were similar at both ages. These effects persist when controlling for earlier cognitive scores. At 24 and 36 months, behavior problem scores for the intervention group were significantly lower than for the follow-up group; the intervention was more efficacious for children with higher initial behavior problem scores. Results are discussed in terms of timing and targeting of services for LBW and disadvantaged children.

Behaviour disorder in pre-school children in Hong Kong. A two-stage epidemiological study

A representative sample of 855 Hong-Kong Chinese children aged 36-48 months were assessed using the BSQ and the PBCL. Good reliability for both instruments were found. For the BSQ and PBCL, 12.75% and 27.5% were above the cut-off points of 10+ and 12+ respectively and 5.9% were above both cut-off points. In the second stage, 234 subjects were recruited by stratified random sampling according to the results of the screening state. A clinician interviewed the parent, child and teacher before making a diagnosis. The prevalence of behaviour disorder was: nil, 53.7%; dubious, 23.1%; mild, 18.0%; moderate, 4.5%; and severe, 0.7%. There were significantly more boys in the categories mild, moderate and severe.

Preschool behavior problems: stability and factors accounting for change

From a sample of high risk children, groups of acting out, withdrawn, and normal preschool children were identified and followed through first, second, and third grade. A high degree of stability of developmental adaptation was found for each group. Examination of the exceptions to predicted outcomes indicated that discontinuity of development was accounted for by level and change in maternal depressive symptomatology, life circumstances, stressful life events experienced by the family, and quality of the home environment. Level of maternal depression appeared to directly affect the quality of care she provided her child, and indirectly affected the quality and organization of the home environment.

Behavioral correlates of developmental expressive language disorder

The association of behavior problems with preschool language disorders has been documented extensively. However, researchers have typically failed to differentiate subgroups of language-impaired children, to use observational data in documenting the behavior disorders, or to study children at the youngest ages. Using a multimodal assessment, this study examined parent-child interaction and behavior problems in a clearly defined subgroup of language-impaired children, those with developmental expressive language disorder (ELD). These children exhibit a delay in expressive language compared with receptive language and nonverbal cognitive skills. Subjects were identified and studied at the youngest age at which the disorder can be assessed. A group of ELD children, averaging 27 months of age, was contrasted with a group of normally developing children, matched for age, sex, and receptive language ability. Groups were compared on observed parent-child interactions as well as maternal responses on the Parenting Stress Index, the Eyberg Child Behavior Inventory, and a behavior-related structured interview. ELD children, when compared with normally developing children, exhibited higher levels of negative behavior and were perceived as different by their parents.