Psychosocial determinants of behaviour problems in Brazilian preschool children

BACKGROUND: This investigation aimed at examining, through an epidemiological study, the social demographic, family and individual determinants of behaviour problems in preschool children. METHOD: Six hundred and thirty-four children, age four years, and their mothers, belonging to a cohort of 5,304 children being followed from birth, took part in the study. During a home visit, the child's behaviour problems and IQ were examined, as well as the prevalence of maternal psychiatric disorder, the quality of the home environment, and other social demographic, family and individual factors. RESULTS: The results revealed a prevalence of children's behaviour problems of 24% (clinical and borderline groups). Regression analysis showed that maternal psychiatric disorder, education and age, number of younger siblings and quality of the home environment explained 28% of the variance of the child's behaviour problems. CONCLUSIONS: The results point to the multi-determination of child behaviour problems.     

Sexual behaviour in Swedish preschool children, as observed by their parents

Issues of what constitutes normal and healthy childhood sexual behaviour have acquired new implications in the light of child sexual abuse. Increased knowledge in this area is therefore of vital importance and studies in different countries are needed. In the present study parents of 231 children aged 3-6 y were asked to answer questionnaires about their child's behaviour at home. The questionnaire consisted of four sections: demographic data, a general behaviour checklist, a sexual behaviour inventory, and attitudinal questions to the parents. The results showed that children in Sweden exhibit a wide range of sexual behaviour, most of them developmentally related. Some behaviour appeared to be very rare in a normative sample of preschool children and included behaviours usually referred to as sexualized and problematic. Reports on sexual behaviour in the children were also related to general behaviour reports, the parent's socioeconomic level, parental attitudes towards child sexuality and the openness of family habits. Conclusion: There is a need for further national studies in different settings, to help create a better understanding of what constitutes both normative and deviant sexual behaviour in children.     

Evaluation of a community intervention programme for preschool behaviour problems

OBJECTIVES: To evaluate an early intervention project focused on improving child prereading skills and parent behaviour-management skills, for 4-year-old children in the western suburbs of Melbourne (Victoria, Australia). METHODOLOGY: Following screening of a large sample of preschoolers, four groups were constructed: (i) children receiving a phonological skills-based prereading package in their normal preschool programme; (ii) children whose parents attended six sessions of child behaviour management skill training; (iii) children who received both interventions; and (iv) a control group. Pre-, post-, 1 and 2 year follow-up measures were taken to assess effects on child behavioural and learning adjustment. RESULTS AND CONCLUSIONS: This community based intervention resulted in positive effects, despite being of low intensity, in achieving significantly less hyperactive/distractable behaviour in children from the combined intervention group at 2 years postintervention. Anxiety problems were also reduced at the post-treatment phase. The prereading package did not demonstrate any effects on reading skills and was deemed to be insufficiently intensive to affect a population of disadvantaged preschoolers. This universal-type of intervention was well accepted by the community, but there is need for further effort to increase recruitment of families of at-risk children into such programmes.     

Maternal intimate partner violence and behavioural problems among Pacific children living in New Zealand

Aims: To examine (1) the association between maternal intimate partner violence (IPV) perpetration and victimisation and behavioural problems among two‐ and four‐year‐old Pacific children, and (2) the socio‐demographic and parenting factors that may impact on this association. Design: Mothers of the Pacific Islands Families (PIF) cohort of Pacific infants born in New Zealand during 2000 were interviewed when the children were two and four years of age. This data set was based on mothers who were cohabiting in married or de‐facto partnerships (N = 920) and who completed measures of IPV at the two‐year assessment point and the Child Behaviour Checklist (CBCL) at the two‐or four‐year assessment points. Of these, 709 mothers completed the CBCL at both assessment points. Results: There were no significant associations between IPV and the prevalence rates of clinically relevant cases of behavioural problems in the two‐year‐old child cohort. However, the prevalence rates of clinically relevant internalising, externalising and total problem cases were significantly higher among four‐year‐old children of mothers who reported severe perpetration of IPV. The odds of being in clinical range of internalising were 2.16 times higher for children of mothers who were perpetrators of severe physical violence than for those children of mothers who were not, and for externalising and total problems they were 2.38 and 2.36 times higher respectively. Socio‐demographic and parenting factors did not significantly influence the association between IPV and child behaviour problems. Conclusion: These findings contribute to the complex picture of the consequences that exposure to parental violence may have on the behaviour of young children. The effectiveness of preventative strategies may be maximised if implemented in these early years before such problems become entrenched and lead on to future behavioural problems and impaired family relationships.     

A prospective study on the persistence of infant crying,sleeping and feeding problems and preschool behaviour

Aim: To determine the persistence of regulatory problems (RP), i.e. excessive crying (>3 months of age), feeding and sleeping difficulties from infancy to preschool age, and to evaluate whether RP at 5 months are predictive of preschool adaptive behaviour and social skills. Method: A prospective population study of newborns admitted to neonatal care. RP at 5, 20 and 56 months of age were obtained via parent interviews and neurological examination and preschool adaptive behaviour and social skills by parent ratings. Logistic and linear regression analyses were conducted and controlled for psychosocial and neurological factors. Results: More than half of the sample had RP at least at one measurement point. In about 8% of infants, RP persisted across the preschool years. Multiple RP and feeding problems increased the odds of eating problems at 20 and 56 months. Persistent RP and feeding problems were predictive of deficits in preschool adaptive behaviour and social skills. In addition, sex differences were found. Conclusions: Multiple RP and feeding problems had the highest stability. Persistent RP were predictive of adverse social and adaptive behaviour. Understanding of the aetiology may help to prevent persistent RP     

Depression in mothers and behaviour problems with their preschool children

A follow-up study of 224 families of a birth cohort of 272 families in a multi-ethnic poor socio-economic municipality in Melbourne when the children were 4 years old showed that 27% of the mothers were depressed. There was no difference in the depression rate between Australian-born and immigrant mothers, a finding in marked contrast to the first year of the study when the depression rate was significantly higher in those immigrant mothers who had been in Australia for less than 3 years, were unable to speak English and who did not have an extended family or close friends. Depression in this group of mothers was attributed to resettlement problems, which over a period of three years had ameliorated. At 4 years the most important factor associated with depression in both Australian-born and immigrant mothers was the quality of marital relationships. Lack of an intimate support relationship made mothers more vulnerable to the stresses of child care and rearing, home-making and life events. In Australian-born mothers only, another significant factor in vulnerability to depression, was their early childhood experiences of being reared in a disruptive home or in an institution and of being unwanted. In immigrant mothers, but not in Australian-born mothers, life events were significantly correlated with depression. The depressed mothers, both Australian-born and immigrant, perceived their 4 year old children to have significantly more behavioural problems than mothers who were not depressed.     

The relationship between children''s treatment-related behaviour problems, age and clinical status in cystic fibrosis

This study examined the relationship between parents' and physicians' reports of treatment-related behaviour and adjustment problems of children with cystic fibrosis (CF), and children's clinical status as assessed by measures of pulmonary functioning and global ratings of clinical status. Parents completed a Cystic Fibrosis Problem Checklist which measures the extent to which children experience behaviour and adjustment difficulties with different aspects of treatment, including chest physiotherapy, medication taking and diet. A high proportion of parents in each age group reported at least some treatment-related behaviour difficulties, with significantly more problems being reported with younger children. There was no significant relationship, however, between the child's age, sex and clinicians' ratings of compliance. A stepwise multiple regression showed that the only variables which significantly predicted clinicians' ratings of the severity of the child's disease were forced expired volume and height. Clinicians' ratings of compliance explained a small amount of extra variance (2.4%). It was found that parental reports of treatment-related behaviour problems were not related to clinical status. The implications of the findings for clinical practice are discussed.     

Behaviour problems in children with language impairment

BACKGROUND: Language impairment is often associated with behaviour problems. However, detailed relations between different types of language impairment and specific behaviour problems in children have yet to be demonstrated. The present study attempted to do just this with an eye to the implications to identify foci for early intervention. METHODS: The language abilities of 71 five-year-old children with language impairment were assessed via the administration of an extensive battery of language tests. The children's behaviour profile was assessed via administration of the Child Behaviour Checklist. RESULTS: Factor analyses confirmed the presence of four language factors: speech, syntax, semantics and phonology. Forty percent of the children displayed serious significant behaviour problems. The most frequently occurring behaviour problems were: withdrawn behaviour, somatic complaints, thought problems and aggressive behaviour. Behaviour problems were associated with three of the four language factors but not strongly associated with speech problems. CONCLUSIONS: Differential relations between specific types of language impairment and specific behaviour problems already exist at a young age. Phonological problems showed broad relations to problem behaviour; semantic language problems were especially related to internalizing behaviour problems. This finding suggests the need for specific therapies for both different types of language problems and different types of behaviour problems.     

Behaviour problems of patients with Moebius sequence and parental stress

Aim: Moebius sequence is a rare condition usually defined as congenital facial paralysis with congenital impairment of ocular abduction. At present, there is little information on behavioural problems, parental stress and possible relationships between these factors. To fill this gap, this study investigated these aspects relevant for counselling. Methods: Parents of 4–17 year old subjects known to the German Möbius syndrome foundation were anonymously asked to fill out several questionnaires, for example, the Child Behavior Checklist (CBCL)4–18. Results: The primary care givers of 41/58 subjects (70.7%) sent back filled‐out questionnaires. Ten subjects did not meet the inclusion criteria; 15 males and 16 females (4; 7–17; 0 years, median age: 10; 7 years) were included. Ten out of 31 subjects were rated as clinical on at least one CBCL scale; three had a total problem score in the clinical range. Social problems were the most important problems with rates of 12–17‐year old subjects being about five times as high as those of younger subjects. Compared with the general population, but not with other parents of mentally and/or physically handicapped children, the primary care givers experienced higher levels of stress, which were correlated to anxious/depressed behaviour, aggressive behaviour, externalising problems and total problem score of the children. The older a child the higher the primary care giver's life satisfaction was. Conclusions: Social problems seem to be frequent among 4–17‐year old subjects with Moebius sequence, and primary care givers show increased strain. Therefore, families with an affected child need early and adequate support.     

Early childhood aetiology of mental health problems: a longitudinal population-based study

Background: Mental health problems comprise an international public health issue affecting up to 20% of children and show considerable stability. We aimed to identify child, parenting, and family predictors from infancy in the development of externalising and internalising behaviour problems by age 3 years. Methods: Design Longitudinal, population‐based survey completed by primary caregivers when children were 7, 12, 18, 24 and 36 months old. Participants 733 children sequentially recruited at 6–7 months from routine well‐child appointments (August–September 2004) across six socio‐economically and culturally diverse government areas in Victoria, Australia; 589 (80%) retained at 3 years. Measures 7 months: sociodemographic characteristics, maternal mental health (Depression Anxiety Stress Scale (DASS)), substance misuse, home violence, social isolation, infant temperament; 12 months: partner relationship, parenting (Parent Behavior Checklist (PBC)); 18, 24 and 36 months: child behaviour (Child Behavior Checklist 1½–5 (CBCL)), PBC, DASS. Results: Sixty‐nine percent of all families attending well‐child clinics took part. The consistent and cumulative predictors of externalising behaviours were parent stress and harsh discipline. Predictors of internalising behaviours included small family size, parent distress, and parenting. Twenty‐five percent of variation in early externalising behaviour and 17% of variation in early internalising behaviour was explained. Conclusions: Effective and cost‐efficient population approaches to preventing mental health problems early in childhood are urgently needed. Programmes must support parents in reducing personal stress as well as negative parenting practices.     

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.     

Parents anticipating misbehaviour: an observational study of strategies parents use to prevent conflict with behaviour problem children

Research on the role of parenting styles in the development of disruptive behaviour problems has focused primarily on how parents handle conflict once it has occurred. This home observational study examined strategies used by 52 mothers to prevent conflict with 3-year-olds. It was predicted that mothers of children with behaviour problems would use fewer "positive" strategies to resolve conflict, and would use reactive rather than pre-emptive strategies. Results showed frequency of positive strategies did not differ between the groups. Mothers of children with behaviour problems were less likely to use pre-emptive, and more likely to use reactive, strategies. Further analysis showed child conduct problems, rather than other characteristics, best discriminated pre-emptive from reactive strategy users. Follow-up of a subsample found that reactive strategies at age 3 predicted age 5 behaviour problems, even after controlling for age 3 behaviour problems.     

Neonatal behaviour characteristics and psychological problems at 6 years

Aim: To examine the predictive capacity of the Neonatal Behavioral Assessment Scale (NBAS) on psychological problems at the age of 6 y. Methods: Eighty full-term infants of optimal health were evaluated at 3 d and 4 wk of age with the NBAS and at 6 y with the Child Behavior Checklist (CBCL) and the Inattention-Overactivity with Aggression Conners Teacher's Rating Scale (IOWA). Results: The NBAS clusters' predictive value was different at 3 d and at 4 wk. Orientation at 3 d and habituation at 4 wk were the best predictors of psychological problems. At 3 d, lower orientation scores and higher motor and habituation scores predicted higher scores in externalizing problems. Externalizing problems were least influenced by background variables. Only in girls were internalizing problems associated with lower orientation scores. At 4 wk, lower habituation cluster scores predicted higher scores in internalizing problems.
Conclusion: These findings suggest that the NBAS could be useful for identifying neonates at risk of later psychological problems.     

Growth patterns, health and illness in preschool children from a multi-ethnic, poor socio-economic status municipality of Melbourne

There are little longitudinal data available for sample populations of Australian children. Previous findings from the Brunswick Family Study, unlike earlier overseas studies, have shown that adverse family and social factors were not associated with growth abnormalities. Follow-up of 224 children from the cohort at 4 years of age has confirmed absence of significant growth disturbances, no mortality between 1 and 4 years, and serious morbidity due to organic illness in only 4% of the sample. However, 22% of the 4 year olds were found to have behaviour disturbances. These findings from a multi-ethnic, poorer socio-economic status population sample illustrate the importance of behaviour disturbances as one aspect of the new morbidity in Australian paediatrics and indicate that the once prevalent growth failure and organic morbidity consequent to family and social disadvantage have all but disappeared.     

Child Behaviour Checklist classification of behaviour disorder

Objective : The aim of this study was to determine the applicability of the published clinical cut-off scores of the Child Behaviour Checklist (CBCL) for the classification of behaviour disorders.
Methodology : Child Behaviour Checklists were obtained for 1342 subjects newly referred to the six major mental health centres in Melbourne. The normative community sample of 1002 7-, 12- and 15-year-olds was drawn from a school-based asthma prevalence study.
Results : The mean total problem T-score for the children referred to mental health centres was 67 and was above the clinical range for all age groups. Using referral to psychiatric services as the gold standard, the sensitivity and specificity of the CBCL using a cut-off of ≥ 60, was 77.4 and 83.2%, respectively. This compares favourably with the sensitivity of 68% and specificity of 82% for the American sample. Using a cut-off score of ≥ 63, the sensitivity was 70.5% and the specificity was 88.6%. The referred and community samples differed with respect to socio-economic status, family structure and mothers' level of education. Fifty-two per cent of the clinically referred children lived with both parents, compared with 89% of the community sample.
Conclusions : While there are some limitations to this study in terms of both the clinic and community sample, support is provided for the usefulness and applicability of the recommended CBCL cut-off scores in an Australian population.     

Twin-Sibling Differences in Parental Reports of ADHD, Speech, Reading and Behaviour Problems

Differences between twins and siblings in behaviour problems were investigated in a non-selected sample of 1938 families with children aged 4-12 years. Families were sent a questionnaire based on DSM-III-R criteria for Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD) and Separation Anxiety (SA), which was validated by formal clinical interview. The questionnaire also included measures of speech and reading problems. There were significant differences between twins and siblings for ADHD symptoms, but not for symptoms of ODD, CD or SA. Twins and siblings differed significantly for gestational age, birth weight, speech and reading problems. While there was little evidence for birth weight or gestational age contributing to the difference in ADHD symptoms, there was a strong association between ADHD symptoms and speech and reading problems.     

The relationship between language development and behaviour problems in children with hearing loss

Background:  There are well-replicated findings that link poor development on a range of communication skills with increased behavioural problems. This paper examines this relationship in children with hearing loss.
Method:  One hundred and twenty children with hearing loss (67 boys, 53 girls) and 63 hearing children (37 boys, 26 girls) with a mean age of 8 years from eight districts in Southern England were assessed for receptive and expressive language skills. The relationships between these measures and an aggregate of parent- and teacher-reported behaviour problems in the children were investigated.
Results:  Children with hearing loss had higher levels of behaviour problems compared to hearing children. Once the language abilities of children with hearing loss are taken into account, the negative effects of hearing loss on behaviour disappear.
Conclusions:  Behaviour problems are found more commonly in children with hearing loss and the level of behaviour problems is highest amongst those children with hearing loss with the least developed language capabilities.