Factors protecting children living in disharmonious homes: maternal reports

Piloting a one-day parent-only intervention in the treatment of youth with anxiety disorders: child and family-level outcomes

OBJECTIVE

Parent-only cognitive-behavioural therapy (CBT) interventions have promise for youth with anxiety disorders. Fear-Less Triple P (FLTP) is one such intervention that has been found comparable to child-focused CBT. Although traditionally administered in six sessions, a one-day workshop format of FLTP was developed to improve accessibility. The current study compared the effectiveness of the six-session and one-day workshop formats.

METHOD

Seventy-three youth (mean age, 8.4 years; 74% male) were randomized to traditional FLTP (6-week group) or the one-day workshop format. Anxiety diagnostic status, self- and parent-reported anxiety symptoms scores, independent evaluator-rated improvement, treatment satisfaction, and measures of family functioning were included to assess treatment outcome. Data were collected prior to treatment, and 1-week, 6-months, and 12-months following treatment.

RESULTS

Both conditions resulted in significant improvement in child anxiety symptom scores per parent report (on both questionnaire and diagnostic interview measures). Furthermore, significant decreases in sibling anxiety were observed in both treatment conditions. There were no statistically significant differences between conditions on any outcome measure.

CONCLUSIONS

Results of this study add to the growing evidence that brief, low-intensity, parent-only interventions can effectively target child psychopathology. These brief interventions are ideal for families for whom the resources and time required to commit to a standard multi-week intervention are prohibitive.

REGISTRATION OF CLINICAL TRIALS

This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12615001284550).

Parental psychological distress and child maladjustment: Exploring the moderating role of sibling relationship quality

The aim of this study was to investigate whether the quality of the sibling relationship moderates the association between parental psychological distress and child maladjustment (i.e., internalizing and externalizing problems). We extended previous literature by studying mothers and fathers separately and by including an observational measure of the quality of the sibling relationship. Participants were 52 two-parent families from a community sample who had at least two children living at home. Only one child (aged 6–10 years) was targeted for the study and studied in relation to his/her siblings. Mothers and fathers completed a self-reported questionnaire on their psychological distress and individually assessed their child’s social-emotional maladjustment. The targeted child’s interactions with his/her siblings were observed by independent judges during a home-visit. Results indicate that both maternal and paternal psychological distress are significant predictors of child social-emotional maladjustment. Moderation analyses reveal that children of distressed fathers are at lower risk of social-emotional maladjustment when they engage in highly positive interactions with their siblings. Post hoc analyses suggest that only sibling empathy (not teaching nor companionship) is a significant moderator of the association between paternal psychological distress and child maladjustment. The results of this study provide further evidence of the influence that fathers have in their child’s development and highlight the importance of using a systemic family approach to promote children’s social-emotional adaptation in the context of parental distress.

Sibling Separation Due to Parental Divorce: Diagnostic Aspects

Separation of siblings is one of the most difficult diagnostic problems faced by psychologists. Such situations are happening more often in the face of the increasing number of divorces and breakdown of relationships. Therefore, a diagnostic task becomes an in-depth assessment of intra-family relationships, ties connecting family members, the preferences of individual people and predicting the long-term consequences of the proposed solutions. The article is dedicated to this problem, and the issue is addressed through the theoretical perspective and the analysis of two cases, i.e., the situation of separated siblings. In the study of children, we present a relatively new method, based on the authors' clinical experience, which could be used to diagnose the family situation of children. The first goal was to analyze the reasons for the separation of siblings whose parents were in conflict during the separation (first case study) and after the separation (second case study), as well as to assess the functioning of the children resulting from the family breakdown, and the decision to separate them from siblings. The analysis allowed identifying the areas of sibling functioning, which should become the subject of diagnosis when working on expert opinions in divorce cases, or cases establishing contact between parents and children. The second aim of the report was to assess the effectiveness of using play as a diagnostic method in a situation that is a source of stress for the child (family breakdown) and causes tension (the diagnostic process in which this topic is discussed).

Exposure to marital conflict: Gender differences in internalizing and externalizing problems among children

Purpose

Marital conflict is integral to children’s psychosocial well-being. Extant research has shown that the effects of marital conflict on children are likely to vary by gender, indicating that gender plays a significant and complex role in the relationship between marital conflict and child adjustment. Focusing on gender, this study investigates the link between specific marital conflict tactics and children’s mental health symptoms in families in which the parents live together.

Methods

This study gathered data from 799 children and their parents in Japan by means of a questionnaire focusing on marital conflict and child behavioral problems. Marital conflict (verbal aggression, physical aggression, stonewalling, avoidance-capitulation, child involvement, and cooperation) was assessed using a Conflict and Problem-Solving Scale. Children’s behavioral problems (externalizing and internalizing symptoms) were assessed using the Strengths and Difficulties Questionnaire.

Results

The findings highlight the significant impact of specific interparental conflict on children’s behavioral problems, demonstrating that there are differences according to the child’s gender. More specifically, multivariate analyses targeting boys revealed that cooperation was significantly inversely associated with externalizing problems and internalizing problems, while avoidance-capitulation and verbal aggression were significantly positively associated with externalizing problems. In contrast, multivariate analyses targeting girls revealed that cooperation was significantly inversely associated with externalizing problems and internalizing problems, while avoidance-capitulation and stonewalling were significantly positively associated with internalizing problems.

Conclusion

This study reveals that interparental conflict is associated with children’s behavioral problems. Constructive marital conflict was significantly inversely associated with externalizing and internalizing problems in both boys and girls. Meanwhile, destructive marital conflict (i.e., avoidance-capitulation and verbal aggression) was significantly positively associated with externalizing problems in boys and significantly positively associated with internalizing problems in girls. These findings contribute to the substantial literature demonstrating the relationship between family processes and the development of disruptive behavior disorders in children.

Association of childhood adversities and home atmosphere with functioning in old age: the Helsinki birth cohort study

Objective

childhood adversities have been linked with adverse health outcomes, but less is known about the long-term consequences of childhood home atmosphere. We investigated whether childhood adversities and home atmosphere were associated with physical and mental functioning in older age.

Methods

in the Helsinki Birth Cohort Study 2003, participants born in the year 1934-44 had data available on nine childhood home atmosphere items, e.g. whether it was supportive and warm (sum score ranged between 0 and 36, higher score indicating better atmosphere), and nine childhood adversities, e.g. unemployment and divorce (sum score 0-9, coded into no; one; and two or more adversities) assessed in 2001-04. Of those, 835 had data on physical and mental functioning assessed using the Short Form 36 questionnaire in 2011-13.

Results

those who had experienced two or more childhood adversities were more likely to have poorer physical and mental functioning in older age compared to those with no adversities. A better home atmosphere score was associated with better mental functioning (per one unit higher score β 0.24, 95% CI 0.16-0.32, P < 0.001). In models including both childhood adversities and home atmosphere, a more favourable home atmosphere was associated with better mental functioning while the association for childhood adversities attenuated. There were no associations between childhood adversities or home atmosphere and physical functioning in the models that included both childhood exposures.

Conclusions

childhood adversities and home atmosphere have long-term associations with physical and mental functioning in older age.

Children's Vulnerability to Interparental Conflict: The Protective Role of Sibling Relationship Quality

This study tested whether the strength of the mediational pathway involving interparental conflict, adolescent emotional insecurity, and their psychological problems depended on the quality of their sibling relationships. Using a multimethod approach, 236 adolescents (M_age  = 12.6 years) and their parents participated in three annual measurement occasions. Tests of moderated mediation revealed that indirect paths among interparental conflict, insecurity, and psychological problems were significant for teens with low, but not high, quality bonds with siblings. High-quality (i.e., strong) sibling relationships conferred protection by neutralizing interparental conflict as a precursor of increases in adolescent insecurity. Results did not vary as a function of the valence of sibling relationship properties, adolescent sex, or gender and age compositions of the dyad.

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

BACKGROUND

Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems.

OBJECTIVES

To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment.

STUDY DESIGN

For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views.

PARTICIPANTS

Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months.

INTERVENTIONS

Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment.

MAIN OUTCOME MEASURES

Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability.

METHODS

Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible.

RESULTS

We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself.

CONCLUSIONS

It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions.

LIMITATIONS

Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses.

FUTURE WORK

Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42013003889.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Integrating Parents' Views on Sibling Relationships to Tailor an Evidence-based Parenting Intervention for Sibling Conflict

Parents play a crucial role in the development of their children's relationships with their siblings. Despite this, relatively few evidence-based parenting programs exist that specifically offer parents the strategies and techniques they desire and require for managing their children's sibling relationships. One way of bridging this gap is to design a tailored parenting intervention for sibling relationships that incorporates the parent voice in various aspects of program design. The current study recruited a convenience sample of 409 Australian parents to complete an online survey relating to their views on difficult sibling behaviors and what, if any, help they desire in dealing with the issue. The majority of respondents were Caucasian, middle- to upper-class mothers. Respondents predominantly attributed the causes of sibling conflict to their child's internal traits, but expressed strong desire for assistance with managing behavioral problems, especially when sibling relationships were marked by physical aggression. Respondents reported high levels of acceptability for positive, rather than punitive, parenting strategies and showed a clear preference for parenting interventions delivered in easy-to-access formats. The findings are interpreted in the context of guiding the development of a tailored parenting intervention for enhancing sibling relationships and reducing conflict.

Self-worth and Social Support of Children Exposed to Marital Violence

The purpose of this study was to examine the relationships among global self-worth (GSW), competencies in various domains, discrepancy between these perceptions of competence and their ratings of importance, and perceived social support of children who were exposed to marital violence using Harter's (1985a, 1985b) theoretical model. Participants were 38 children aged 7 to 12 years. Children individually completed measures assessing their GSW, domain-specific competencies, perceived importance of each domain, and perceived emotional support from several significant individuals in their lives. The findings are consistent with Harter's model in which perceived social support and the perception of success in domains children believe to be important are related to their GSW. Specifically, children's perceived competencies in physical appearance, behavioural conduct, scholastic achievement, and popularity are strongly related to their GSW. Emotional support from mothers and close friends is more strongly related to children's GSW than support from teachers and non-kin adults.

School Work, Teachers, and Peers: The World of First Grade

Children’s perceptions of their experiences with their school work, and teacher and peer relationships were studied in 44 second-born children, participating with their mothers and siblings in a longitudinal investigation, who were interviewed in October and May of their first-grade year. Overall, the majority of children were very positive about their experiences in all three areas of school adjustment. Modest associations between children’s perceptions of their school work, teacher, and peer experiences suggest that although most children perceived their experiences as positive (or negative) across all three areas, some children reported difficulties in one or two individual areas. In addition, although many children’s reported school experiences remained stable over the year, some children’s perceptions changed. The majority of children whose perceived school experiences were marked by discontinuity over the year were positive at the beginning of the year but relatively negative at the end. Finally, the findings from this investigation draw attention to some of the antecedent variables related to children’s subsequent school experiences, in particular, their emotion understanding and earlier relationships with their older siblings.

Influence of Family Adversity on School-Related Behavioural Problems among Multi-Ethnic High School Students

This study examines the influence of family adversity indicators on school-related behavioural problems among Hawaiian and non-Hawaiian adolescents. Questionnaire data from 2787 students were linked to school information, including grade point average (GPA), absences, suspensions and conduct infractions. Logistic regression analyses were performed. The cumulative effect revealed higher increases in the odds ratios for school-related behavioural problems among non-Hawaiians. Surprisingly, there was no cumulative effect of family adversity among Hawaiian adolescents. Given their high rates of adversity and behavioural problems, any family adversity may significantly impact this group. The family environment must be considered in the prevention and intervention of school-related behavioural problems.

Family process and youth internalizing problems: A triadic model of etiology and intervention

Despite major advances in the development of interventions for youth anxiety and depression, approximately 30% of youths with anxiety do not respond to cognitive behavioral treatment, and youth depression treatments yield modest symptom decreases overall. Identifying networks of modifiable risk and maintenance factors that contribute to both youth anxiety and depression (i.e., internalizing problems) may enhance and broaden treatment benefits by informing the development of mechanism-targeted interventions. A particularly powerful network is the rich array of family processes linked to internalizing problems (e.g., parenting styles, parental mental health problems, and sibling relationships). Here, we propose a new theoretical model, the triadic modelof family process, to organize theory and evidence around modifiable, transdiagnostic family factors that may contribute to youth internalizing problems. We describe the model's implications for intervention, and we propose strategies for testing the model in future research. The model provides a framework for studying associations among family processes, their relation to youth internalizing problems, and family-based strategies for strengthening prevention and treatment.

Associations Between Sibling Relationship Quality and Friendship Quality in Early Adolescence: Looking at the Case of Twins

Bidirectional pathways between twin relationship quality and friendship quality were investigated in a large longitudinal twin cohort. We examined negative and positive relationship features in 313 monozygotic (MZ) twins and 238 same-sex dizygotic (DZ) twins from ages 13 to 14 years, using latent structural modeling. Results showed stronger stability of the twin relationship quality compared to friendship quality. Positive features in the sibling relationship were associated with increased positive features in the relationship with the best friend a year later. In contrast, no significant association between negative sibling relationship features and change in negative friendship quality features was found. These findings speak to the important role of the sibling relationship in the development of good quality friendship relations in twins.

Parent Psychopathology and Children's Psychological Health: Moderation by Sibling Relationship Dimensions

Offspring of anxious adults are at heightened risk for psychological maladjustment; however factors that protect youth in the context of this risk have been rarely explored. Supported by literature showing the meaningful role of sibling relationships for children's psychological outcomes, this study examined the protective role of the sibling relationship for children in the context of risk for psychological maladjustment due to having a parent with a clinical anxiety disorder. Participants were 81 children ages 7 to 12 years (58% female; 82 % Caucasian), and their parents. Parents met DSM-IV-TR diagnostic criteria for a primary anxiety disorder, and youth did not meet diagnostic criteria for any psychiatric disorder. Parents completed questionnaires on their own psychological distress and use of parenting behaviors, and on their children's psychological adjustment. Children self-reported on the quality of their sibling relationship based on their closest-age sibling. Parenting behaviors were also coded based on a parent-child interaction task. Results of hierarchical regression models demonstrated that sibling relationship quality moderated the relation between parental psychological distress and child adjustment. Post-hoc simple slopes analyses showed that parental distress was significantly positively associated with greater child psychological problems only for children reporting low sibling companionship or high sibling conflict. Aspects of the sibling relationship did not moderate the association between self-rated or observer-rated parenting behaviors and child anxiety symptoms. Findings are consistent with developmental models and empirical literature emphasizing the protective role of sibling relationships for youth's psychological outcomes. Sibling relationships may be a salient target for youth psychological preventive or treatment interventions.

[The mental health of only children and of siblings with cancer - first results of a multicenter study in Germany]

BACKGROUND

Children of parents with cancer are at risk of developing mental disorders. RESULTS from divorce research also reveal that sibling relationships can protect the mental health of children in difficult times.

OBJECTIVE

Does having a sibling help to cope with an oncological disease of a parent and thus act as a protective factor?

METHODS

A group of 271 children were examined in a multicenter study. 54 % made use of the offered psychosocial support. Only children (N = 89) and children with siblings (N = 182) were compared with respect to their mental health (Strength and Difficulties Questionnaire, SDQ, parental and self-assessment).

RESULTS

The group comparison between only children and siblings showed no significant differences in the SDQ (assessed by healthy/ill parent). In the self-assessment 2 % of the only children and 9 % of the siblings showed significant results on the SDQ. The group comparison between only children and children with siblings failed to reveal any important differences in mental health. The study indicates that a negative relationship quality (Sibling Relationship Questionnaire, SRQ) is associated with increased problems in the peer group.

CONCLUSIONS

The existence of a sibling is not per se a protective factor. Only children do not show more signs of emotional stress than children with siblings.

Positive and Negative Interactions Observed Between Siblings: Moderating Effects for Children Exposed to Parents' Conflict

This study investigated links between interparental conflict appraisals (specifically threat and self-blame), sibling relationship quality (positive and negative dimensions), and anxiety in sibling pairs comprised of an adolescent and a younger sibling close in age. Sibling relationship quality was measured through behavioral observation. Links between self-blame and anxiety were moderated by sibling relationship quality. In older siblings, positive behavior with a sibling was associated with an attenuated relation between self-blame and anxiety. A paradoxical moderating effect was found for negative interactions; for both younger and older siblings, a relation between self-blame and anxiety was weakened in the presence of sibling negativity. Results offered support for theorized benefits of sibling relationship quality in helping early adolescents adjust to conflict between parents.

Longitudinal associations between sibling relationship qualities and risky behavior across adolescence

This study examined the associations between sibling intimacy and conflict and youths' reports of risky behavior in a sample of adolescents ages 11-20. Participants were mothers, fathers, and sibling dyads in 393 families who were interviewed annually for 3, 4, or 5 years. Multivariate multilevel models tested longitudinal links between sibling intimacy and conflict and youths' risky behavior and whether these associations were moderated by birth order, sex, or dyad sex constellation. Controlling for parent-youth conflict, the results showed positive within-person covariation between sibling conflict and risky behavior for all youths except firstborns with younger brothers. Controlling for parent-youth intimacy, sibling intimacy was positively linked with risky behavior at the between-person level, but only in brother-brother pairs. The discussion focuses on sibling relationships as a context for adolescents' individual development and the roles of birth order, sex, and dyad sex constellation.

The third rail of family systems: sibling relationships, mental and behavioral health, and preventive intervention in childhood and adolescence

Sibling relationships are an important context for development, but are often ignored in research and preventive interventions with youth and families. In childhood and adolescence, siblings spend considerable time together, and siblings' characteristics and sibling dynamics substantially influence developmental trajectories and outcomes. This paper reviews research on sibling relationships in childhood and adolescence, focusing on sibling dynamics as part of the family system and sibling influences on adjustment problems, including internalizing and externalizing behaviors and substance use. We present a theoretical model that describes three key pathways of sibling influence: one that extends through siblings' experiences with peers and school, and two that operate largely through family relationships. We then describe the few existing preventive interventions that target sibling relationships and discuss the potential utility of integrating siblings into child and family programs.

Family relationships and children's stress responses

In this chapter, the theoretical and empirical associations between family relationships and children's responses to stressors are reviewed. Family relationships explored are primarily dyadic, representing the emphasis of past empirical research; these include parent-parent, parent-child, and sibling relationships. However, in recognition of the more complicated and interconnected nature of family relationships, also reviewed are associations between the broader family context and children's stress responses. Multiple measures of stress responses are considered, including both physiological and emotional responses to and recovery from stressful experiences. Overall, the studies reviewed suggest that poor-quality family environments, including those characterized by low emotional support or high conflict, are associated with dysregulated stress responses throughout childhood and adolescence. In contrast, children and adolescents in families with high emotional support or low conflict seem to be protected from developing stress regulatory problems. Limitations in this body of research as well as directions for future research are discussed.

Neurobiological and psychiatric consequences of child abuse and neglect

The effects of early-life trauma and its consequences for the treatment of depression are reviewed. The prevalence and clinical sequelae of early sexual and physical abuse, neglect and parental loss are described. An overview of preclinical studies that help guide clinical research and practice is presented. Human clinical studies on the neurobiological consequences of early trauma are summarized. Moderating factors, such as genetic variation and sex differences, are discussed. The few current treatment outcome studies relevant to this research area are described. Guidance for the management of patients with depression and a history of child abuse and neglect are provided. Most patients who have experienced early traumatic experiences are likely best treated with a combination of psychotherapy and pharmacotherapy. This review is dedicated to the memory of Seymour Levine who pioneered the field of early experience research and to a considerable extent inspired the clinical studies described in this review.

Family-centred HIV interventions: lessons from the field of parental depression

Traditionally, HIV prevention focuses on individual behaviours that place one at risk for HIV infection. Less widely regarded as a fundamental public health issue is parental depression and the detrimental effects it exerts on infant and child development, as well as its key contribution to non-fatal burden. Much like many HIV prevention and treatment interventions, programmes for depression focus almost exclusively on individuals and individual behaviour. This paper will use the extensive evidence base from research into parental depression as a model to argue for a family based approach to HIV prevention and treatment. The aim of this will be to make a case for targeting a broader set of behaviours that occur within families when developing and implementing interventions.

Family relationships and the psychosocial adjustment of school-aged children in intact families

The authors investigated whether the quality of three family relationships (i.e., marital, parent-child, sibling) in intact families are associated with each other and with children's psychosocial adjustment. Data were collected by means of maternal and child reports (N = 88) using standardized instruments (i.e., Marital Satisfaction Scale, Strengths and Difficulties Questionnaire). The findings confirm associations between the marital and the parent-child relationship, and between the parent-child and the sibling relationship, Further, both father-child relationships and sibling relationships predict children's adjustment. Father-child conflicts contribute to children's problem behavior, while father-child acceptance and sibling affection contribute significantly to children's general self-esteem. However, contrary to previous studies no support was found for the association between marital relationship and sibling relationship, or for that between marital relationship quality and children's adjustment.

Protective and resource factors in highand low-risk children: A comparison of children with unipolar, bipolar, medically ill, and normal mothers

This study distinguished between factors that were protective for children at high risk and those that were resources for children regardless of risk level and determined the generality of these factors across three different risk definitions: school-age children of mothers with (a) unipolar depression (n = 22), (b) bipolar disorder (n = 18), and (c) medical illness (n = 18), each compared to a low-risk control group (n = 38). Results were verified at a 1-year follow-up. Positive self-concept, academic success, social competence, and positive perceptions of the mothers were resource factors associated with lower diagnostic ratings for children in all risk groups. Maternal social competence and having a healthy father in the home were resource factors for maternal unipolar risk but, unexpectedly, were vulnerability factors for maternal bipolar risk. Children's friendships were protective for children of medically ill mothers; however, frequent contact with an adult friend was a risk factor for unipolar offspring. The latter finding suggests that such contact might be a consequence of poor parent-child relationships. Findings are discussed in terms of possible interventions for children at risk, and suggestions for additional research are offered.

Sibling separation and psychological problems of double AIDS orphans in rural China - a comparison analysis

OBJECTIVE

We investigated the psychological impact of sibling separation among children who lost both of their parents to AIDS and were placed in group care or kinship care settings in rural China.

METHODS

Comparative analysis of cross-sectional survey data among 155 children among whom 96 experienced sibling separation. Trauma symptoms (Anxiety, Depression, Anger, Post-traumatic stress, Dissociation, Sexual concerns) were compared between the AIDS orphans who experienced sibling separation and those who did not using analysis of variance and multivariate analysis of covariance.

RESULTS

Among the participants (47.7% girls) with an average age of 12.4 years, univariate and multivariate analyses showed that separation from siblings was associated with significantly higher scores in anxiety, depression, anger and dissociation before or after controlling for gender, age, care arrangement, number of household replacement, trusting relationship with the current caregivers and perceived quality of current living condition. Sibling separation among orphans was not associated with level of post-traumatic stress and sexual concerns.

CONCLUSION

AIDS orphans separated from their siblings suffered from increased psychological distress compared with those who remained with their siblings. The data in the current study suggest that care arrangement for AIDS orphan should include accommodating the siblings together or providing them with opportunities for frequent contact and/or communication with each other. Appropriate psychological counselling should be given to those orphans experiencing sibling separation.

Using therapeutic board games to promote child mental health

This article focuses on group work with children using a board game format. Combining the principles of group work and board games helps to engage and motivate children and adolescents to address and work through their difficulties. Lifegames are a series of six therapeutic board games developed for group work with children and adolescents who encounter adversity in their life as a consequence of bereavement, family break up, poor relationships, bullying, chronic illness or obesity. The games facilitate the understanding and disclosure of the complex feelings experienced by children and young people when they are confronted with traumatic life events. The games encourage and assist the participants to obtain and maintain behavioural change. Lifegames are a means to assist professionals in their group work with children and adolescents.

The role of attachment in the early development of disruptive behavior problems

This paper presents information pertaining to attachment processes as risk factors in the development of disruptive behavior in young children. In recognition of the fact that attachment is not the only or necessarily most important risk factor in the prediction of behavior problems, attachment is considered in the context of other domains of variables, including child biologic factors, family ecology, and parental management and socialization practices. Within the attachment domain, we describe three complementary processes that may lead to disruptive behavior: the information-processing aspects of affective-cognitive structures, the function of observable attachment patterns, and the motivational consequences of attachment security. The indirect effects of maternal representations of attachment on child disruptive behavior are also considered. Examples of protypical risk factor combinations involving attachment and other domains are provided. The implications of the attachment perspective for research and clinical work with young disruptive children are discussed.

Distinguishing family-level and child-level influences on the development of depression and aggression in children at risk

This study examined family-level and child-level influences on diversity in depression and aggression among children at risk. Data were from 144 children aged 7–14 years. A procedure introduced by Lavori, Keller, Beardslee, and Dorer (1988) was used to correct for the inclusion of more than one child from each family. Family-level influences examined were maltreatment and parental psychopathology. Maladjustment was highest in children of psychiatrically ill parents from maltreating homes and lowest in children of psychiatrically ill parents from nonmaltreating homes. Child-level influences examined were social cognition, intelligence, early developmental difficulties, sex, and age. Independent of family risk status, younger male children with high social-cognitive skills and no early developmental difficulties were least depressed. Child characteristics were less predictive of aggression. Overall, this study shows that efforts to explain diversity in high-risk children's development benefit from attending to all the offspring of high-risk parents and to multiple interacting family risk factors.

The Ethnic Context of Child and Adolescent Problem Behavior: Implications for Child and Family Interventions

This article links the empirical literature on race and ethnicity in developmental psychopathology with interventions designed to reduce adolescent problem behavior. We present a conceptual framework in which culture is endogenous to the socialization of youth and the development of specific self-regulatory strategies. The importance of cultural influence is identified at three levels: (a) intrapersonal developmental processes (e.g., ethnic identity development, development of coping modifies mechanisms and self-regulatory mechanisms), (b) family socialization processes (e.g., racial and ethnic socialization), and (c) interaction with larger societal contexts (e.g., maintenance of bicultural competence in adapting to mainstream and ethnic cultures). We discuss limitations of current assessment and intervention practices that focus on reducing adolescent problem behavior with respect to the cultural issues identified above. We propose that empirically supported adaptive and tailored interventions for adolescent problem behavior are optimal for serving multicultural children and families. To empower such interventions to better serve children and families of color, it is essential that assessments that guide the adaptation and tailoring process include culturally salient dynamics such as ethnic identity, racial socialization, and culturally informed parenting practices.

Are sibling relationships protective? A longitudinal study

BACKGROUND

Although the protective effects of familial and parental support have been studied extensively in the child psychopathology literature, few studies have explored the protective quality of positive sibling relationships.

METHODS

A two-wave longitudinal design was used to examine the protective effect of positive sibling relationships on child adjustment for children experiencing stressful life events. Mothers reported on stressful life events and child adjustment. Older siblings assessed the quality of relationship between themselves and target children.

RESULTS

Sibling affection moderated the relationship between stressful life events and internalizing symptomatology but not the relationship between stressful life events and externalizing symptomatology. Notably, the protective effect of sibling affection was evident regardless of mother-child relationship quality.

CONCLUSIONS

Positive sibling relationships are an important source of support for children experiencing stressful life events. Implications for intervention are discussed.

Depressive Symptoms Among Delinquent Youth: Testing Models of Association with Stress and Support

The high prevalence of depression among incarcerated youth indicates a need to better understand factors that contribute to depression within this vulnerable subgroup. Previous research in general community samples has suggested that high levels of stress and low levels of parental support are associated with depression in young people, but it is unclear whether or how they might be associated with depression among incarcerated youth who are already vulnerable. Using a sample of 228 adolescents (aged 13-18 years) who were detained in the juvenile justice system, stress and support were modeled as independent main effects and as interactive risk factors in relation to depressive symptoms. More stressful life events and less caregiver support were each independently associated with depressive symptoms, but no evidence was found for the buffering hypothesis in this sample. Stressful life events were more strongly associated with depressive symptoms among boys compared to girls.

Stressors and child and adolescent psychopathology: evidence of moderating and mediating effects

This paper reviews studies that have tested for moderators or mediators of the relation between stressors and child and adolescent psychopathology. Many studies have tested for moderation, but results of research studying moderators have been inconclusive. There have been few theory-based studies and there have been few consistent findings. Far fewer studies have tested for mediation effects, but these studies have generally been theory-driven, have more often built upon one another in an incremental fashion, and have yielded consistent results. In particular, there is substantial evidence for the mediating role of family relationship in the relation between stressors and child and adolescent psychological symptoms. Future studies should integrate moderator and mediator research by testing for specific mediators in relation to particular moderating contexts, so that we can better understand the complex ways in which stressful life experiences affect the well-being of children and adolescents.

Maternal appraisal styles, family risk status and anger biases of children

The present study investigated the relationship between maternal appraisal styles, family risk status, and anger biases in children. Participants included 90 mothers and their children between 3-6 years of age. Eighty families were followed up 1 year later. Maternal appraisal styles were assessed via a naturalistic story-reading method, and Time 1 and Time 2 emotion biases included teacher ratings of anger and aggression, peer ratings of anger, as well as classroom and playground observations of anger. While discussing ambiguous stories with their children, mothers with higher scores on the family risk index utilized more hostile appraisals and fewer prosocial appraisals in their explanations. A higher proportion of hostile-to-prosocial appraisals was also related to higher-risk family status. Prosocial appraisals by mothers were inversely correlated with children's anger biases at school. When the appraisal balance in mothers' talk favored hostile appraisals, children tended to show higher levels of anger biases evidenced at school. Finally, a hostile balance of maternal appraisals was found to predict change in children's anger biases in the school with different effects in high- and low-risk families.

Mutual influence of marital conflict and children's behavior problems: shared and nonshared family risks

This within-family, longitudinal study including biological and stepfamilies investigated mutual influences between marital conflict and children's behavior problems. Children (4 to 17 years; N=296) residing in 127 families drawn from a general population study were investigated at Time 1 and again 2 years later. These nested data were analyzed using multilevel modeling, controlling for previous child behavior or marital conflict. Marital conflict about children predicted change in children's behavior. Children's behavior also predicted an increase in marital conflict, particularly in stepfamilies. Differences between siblings in exposure to conflict and the extent to which siblings were a source of argument increased more in stepfamilies than in biological families. Boys were exposed to more conflict over time than were girls.

Bullied by siblings: association with peer victimisation and behaviour problems in Israeli lower secondary school children

BACKGROUND

The association of bullying victimisation by siblings with a) involvement in bullying at school and b) behaviour problems among lower secondary school children in Israel was investigated.

METHOD

Self-report questionnaires of sibling victimisation, peer bullying experiences and behaviour problems were completed by 921 pupils aged 12-15 (mean age 13.7 years).

RESULTS

Of the sample, 16.2% were directly bullied by their siblings at home and 11.9% were direct victims of bullying by peers at school every week. More than half of victims of bullying by siblings (50.7%) were also involved in bullying behaviour at school compared to only 12.4% of those not victimised by siblings, indicating a strong link between intrafamilial and extrafamilial peer relationships. Children with poor sibling and peer relationships were at a highly increased risk for behaviour problems. Ethnic (Israeli Jewish vs. Arab) and sex differences were small compared to the effects of sibling relationship on behaviour problems.

CONCLUSION

Intervention strategies directed at reducing bullying in school should take into account pupils' experiences of victimisation by siblings at home.

Emotional resilience: risk and protective factors for depression among alternative education students in New Zealand

A total of 268 alternative education students from New Zealand were surveyed to examine risk and protective factors for depression within the social environment. Twenty-eight (35.4%) of the girls and 31 (21.1%) of the boys had cut-off scores that indicated a high likelihood of significant psychopathology from depression. Multivariate analysis demonstrated that family and peer connections were protective against depression. High levels of poverty, witnessing violence at home, and experiencing bullying at school were significant risk factors for depression.

A Model of Childhood Perceived Peer Harassment: Analyses of the Canadian National Longitudinal Survey of Children and Youth Data

The authors developed a model of childhood perceived peer harassment, using several personality, peer, and familial characteristics of victims, and tested it with children 10 to 11 years old (N = 3,434) drawn from the Canadian National Survey of Children and Youth, which is a stratified random sample of 22,831 households in Canada. A 3-step analytic procedure with 3 separate subsamples of the children was used to explore psychosocial correlates of peer harassment. Results from the latent variable path analysis (comparative fit index = .90) showed that victims are likely to feel anxious and disliked by their peers. Their parents reported using high levels of control and low levels of warmth with their children and reported high levels of depression and marital conflict themselves. These results are discussed from a social-cognitive perspective.

The role of father involvement in children's later mental health

Data on 8441 cohort members of the National Child Development Study were used to explore links between father involvement at age 7 and emotional and behavioural problems at age 16, and between father involvement at age 16 and psychological distress at age 33, controlling for mother involvement and known confounds. Father involvement at age 7 protected against psychological maladjustment in adolescents from non-intact families, and father involvement at age 16 protected against adult psychological distress in women. There was no evidence suggesting that the impact of father involvement in adolescence on children's later mental health in adult life varies with the level of mother involvement.

Stress and psychopathology in children and adolescents: is there evidence of specificity?

Research on the relations between specific stressors and specific psychological outcomes among children and adolescents is reviewed. Specificity, the notion that particular risk factors are uniquely related to particular outcomes is discussed from a theoretical perspective, and models of specificity are described. Several domains of stressors are examined from a specificity framework (e.g., exposure to violence, abuse, and divorce/marital conflict) in relation to broad-band outcomes of internalizing and externalizing symptoms. Studies that tested for specificity conducted within the past 15 years are examined, and definitional problems are highlighted. Little evidence for specificity was found. Methodological problems in the literature and the lack of theory-driven specificity research are discussed, and directions for future research are identified.

Psychosocial adjustment in siblings of children with autism

BACKGROUND

This study investigated psychosocial adjustment in siblings of children with autism compared to siblings of children with Down syndrome and siblings of normally developing children. In addition, the relationships between feelings of loneliness, social support and psychosocial adjustment, and the influence of gender and family size on psychological adjustment were examined.

METHODS

Ninety siblings (30 per group) between the ages of 8 and 18 and one parent of each child participated in this study.

RESULTS

Results indicated that siblings of children with autism, as well as comparison siblings, were well adjusted and reported low levels of loneliness. Siblings of children with autism also reported that they received high levels of social support in their lives.

CONCLUSIONS

Large family size appears to facilitate healthy adjustment in siblings of children with autism.

Effects of marital conflict on children: recent advances and emerging themes in process-oriented research

BACKGROUND

The effects of marital conflict on children's adjustment are well documented. For the past decade research has increasingly focused on advancing a process-level understanding of these effects, that is, accounting for the particular responses and patterns embedded within specific contexts, histories, and developmental periods that account for children's outcomes over time.

METHODS

As a vehicle for presenting an update, this review follows the framework for process-oriented research initially proposed by Cummings and Cummings (1988), concentrating on recent research developments, and also considering new and emerging themes in this area of research.

RESULTS

In this regard, areas of advancement include (a) greater articulation of the effects of specific context/stimulus characteristics of marital conflict, (b) progress in identifying the psychological response processes in children (e.g., cognitive, emotional, social, physiological) that are affected and their possible role in accounting for relations between marital conflict and child outcomes, (c) greater understanding of the role of child characteristics, family history, and other contextual factors, including effects on children due to interrelations between marital conflict and parenting, and (d) advances in the conceptualization of children's outcomes, including that effects may be more productively viewed as dynamic processes of functioning rather than simply clinical diagnoses.

CONCLUSIONS

Understanding of the impact of marital conflict on children as a function of time-related processes remains a gap in a process-oriented conceptualization of effects. Based on this review, a revised model for a process-oriented approach on the effects of marital discord on children is proposed and suggestions are made for future research directions.

Influences of marital conflict on child adjustment: review of theory and research

This review summarizes the literature on the relationship between marital conflict and child maladjustment with an emphasis on variables that qualify, explain the association, or both. Following a historical review, the modest findings on the strength of the association between marital conflict and child maladjustment is explored. The definition of marital conflict is clarified through specification of its various dimensions (frequency, intensity, content, resolution). The role of variables that serve to moderate and/or mediate the relationship between marital conflict and child maladjustment are elaborated. Mediating models include exposure theories (Modeling, Cognitive-Contextual effects: appraisal of threat and blame, and Emotional Insecurity) and changes in the parent-child relationship (Spillover). Variables that moderate or qualify the relationship include children's cognitions and behaviors, contextual factors, and demographic differences. A model is presented summarizing these mechanisms. Research recommendations are proposed and the clinical implications of this literature are addressed.