Infant and toddler pathways leading to early externalizing disorders

OBJECTIVE

To examine pathways leading to specific types of early externalizing disorders.

METHOD

Longitudinal data were collected on 310 low-income, male subjects followed from infancy until age 6 years.

RESULTS

Support across informants was found for the importance of the caregiving environment during infancy in relation to the development of externalizing disorders at school entry. Support was also found for the significance of early child factors, but this was limited to child behavior at home.

CONCLUSIONS

The results are consistent with social learning and attachment models, which suggest that severe conduct problems in early childhood are the result of deficits in the caregiving environment. Support was also found for Moffitt's hypothesis that children with the comorbid attention-deficit/hyperactivity disorder-oppositional defiant disorder/conduct disorder pattern experience multiple child and psychosocial risk factors that begin during infancy.

Destructive sibling conflict and the development of conduct problems in young boys

Little empirical work has explored the relation between destructive sibling conflict and conduct problems in children. This study used a measure of observed sibling conflict to examine its relations with maternal and teacher report of conduct problems in a low-income sample of 180 five-year-old boys and their close-age siblings. Early report of behavior problems and rejecting parenting were added to the analyses to control for these predictors and to examine interactive effects. The interaction between destructive sibling conflict and rejecting parenting predicted aggressive behavior problems across time and informants such that a rise in aggression scores was evident for children who had high levels of both sibling conflict and rejecting parenting. Sibling conflict was also directly related longitudinally to the Child Behavior Checklist Delinquency factor. Results are discussed in terms of additive risk models and G. R. Patterson's (1984, 1986) theory of coercion.

A longitudinal study of interparental conflict, emotional and behavioral reactivity, and preschoolers' adjustment problems among low-income families

Researchers have begun to develop models that explain the processes by which interparental conflict impacts children's adjustment. The present study tested a model based on emotional security theory. The longitudinal relations among interparental conflict, boys' reactions to conflict, and internalizing and externalizing problems were examined in a sample of 129 mother-son dyads from low-income, 2-parent families from the time sons were age 2 to 5. Results indicated that children exposed to interparental conflict were more likely to have concurrent and later behavior problems and that patterns of interparental conflict across time made unique contributions in predicting later problems. Children's emotional reactivity in response to conflict had no direct relation to interparental conflict and only modest relations to behavior problems. However, interparental conflict and reactivity factors interacted to predict behavior problems at ages 3 1/2 and 5. Thus, some support was demonstrated for emotional reactivity as a moderator in the development of young children's behavior problems.

A prospective study of the effects of marital status and family relations on young children's adjustment among African American and European American families

The present study investigated the effects of divorce and family relations on young children's development prospectively, using an ethnically diverse sample of approximately 300 low-income families. We also were able to examine the moderating effects of ethnicity on child adjustment in always two-parent, to-be-divorced, already-divorced, and always single-parent families. Results indicated that to-be-divorced European American and African American families demonstrated higher rates of preschool-age behavior problems, and already-divorced families showed similar trends. Parental conflict and behavior problems accounted for predivorce differences in child behavior problems, whereas rejecting parenting accounted for differences in problem behavior between always single-parent and always two-parent families. The results are discussed in terms of the importance of ethnicity in influencing young, low-income children's adjustment to different family structures.

Young children's adjustment to chronic family adversity: a longitudinal study of low-income families

OBJECTIVE

To test the relation between multiple family stressors and young children's adjustment problems.

METHOD

Longitudinal data were collected on 300 low-income, ethnically diverse, male subjects beginning during infancy and followed until age 31/2.

RESULTS

General support was found for the family stressor hypothesis. Stressor groups at 18 and 24 months predicted Child Behavior Checklist Externalizing and Internalizing factors at 24 and 42 months, including clinically elevated problems.

CONCLUSIONS

The results confirm and extend previous investigation of the family stressor hypothesis. They suggest that psychological evaluations of young children need to be ecologically based, including intra- and extrafamilial factors that appear to cumulatively increase risk of behavior problems.

The development of early externalizing problems among children from low-income families: a transformational perspective

The present study examined pathways leading to early externalizing problems from age 1 to 3 1/2 in a design that took advantage of our knowledge of normative progression and normative socialization as well as findings from research on risk. A sample of 130 low-income participants was followed longitudinally from 12 to 42 months using observational measures of developmentally salient parenting and child disruptive behavior to predict early externalizing problems. Results are best accommodated by concepts such as transformation and transaction from developmental psychology. For boys, both child and parent variables predicted later externalizing. For girls and boys, the interaction between child noncompliance and maternal rejection was significant.

Spinal cord injuries associated with cardiopulmonary complications

Twenty-two of 83 consecutive patients with traumatic quadraplegia admitted to a regional spinal injury center had significant bradycardia. These bradycardic patients accounted for 66% of the cervical spinal cord injured patients' mortality. In general, bradycardia in patients with cervical spinal cord injuries appears to be due to unopposed vagal tone. This bradycardia is self-limited within 3-5 weeks after the onset of paraplegia and does not require permanent pacemaker therapy.

Rehabilitation of the cardiac patient. Program phases and rationale

Management of cardiac patients has clearly changed, with increasing encouragement of early activity. The four-part rehabilitation program described here begins in the coronary care unit and continues well past discharge from hospital.

Acute hemodynamic effects of dopamine in patients with shock

The hemodynamic effects of dopamine were studied in 62 patients with clinical shock. In 36 patients with infection dopamine increased mean arterial pressure (MAP) 30%, and cardiac output (CO) 37%. Urine flow (UF) increased from 0.5 ml/min to 1.6 ml/min. Norepinephrine (NE) in 26 patients resulted in a higher MAP, lower CO, and similar UF. Isoproterenol (Isp) in 19 patients resulted in a lower MAP, higher CO, and a significantly lower UF. In 13 patients with cardiogenic shock dopamine increased MAP 6%, and CO 40%. UF increased from 0.6 ml/min to 1.1 ml/min. NE in eight patients resulted in a lower CO than during dopamine infusion, and Isp in five patients resulted in a higher CO. Dopamine improves MAP pressure, CO, and UF when shock is due to infection and is superior to Isp which does not increase perfusion pressure to adequate levels and does not improve UF. In patients with cardiogenic shock who have reduced CO and increased systemic vascular resistance, perfusion pressure tended to be adequate, and improved CO occurred with dopamine and Isp but not with NE. Although Isp increased CO more than dopamine, differences in regional perfusion are important in selection of the best inotropic agent and in most patients make dopamine the preferred agent.