Family Functioning and Behavioral Adjustment in Children With Leukemia and Their Healthy Peers

In this study we investigated differences in child adjustment and family functioning of 33 children with leukemia and 32 healthy children, examined unique relationships between familial factors and adjustment within each group, and used demographic and family variables to predict child adjustment for both groups. Results indicated that the families of children with leukemia rated themselves as less cohesive and more conflictual than did the families of healthy children. We found no differences in child adjustment between children with leukemia and healthy children; both groups scored well within normal ranges. However, we found different associations between family functioning and child adjustment for the two groups. For the children with leukemia, greater family conflict and less encouragement of autonomy were associated with greater child externalizing symptoms, whereas lower family cohesion, less open expression, and higher levels of control within the family were associated with more child internalizing problems. For the healthy children, family personal growth was associated with better adjustment (i.e., fewer child internalizing problems). We predicted child adjustment using hierarchical multiple regression analyses and we discuss implications of these findings for a family systems approach in pediatric psychology.     

Feeding and sleeping problems in infancy – a follow‐up at early school age

Background Feeding and sleeping problems are common during infancy. Many regulatory problems of this kind are connected to various child and family factors. This study is a follow‐up of children with early feeding and/or sleeping problems, 6 years after clinical contacts. Methods A total of 230 families (72%) participated in the questionnaire follow‐up. Children and parents were compared with 227 (71%) reference families regarding sleeping and feeding problems, health factors in parent and child, psychosocial problems, stressful life events, social support, life satisfaction, and externalizing and internalizing behaviour in the child. Results Six years after clinical contacts the children with early feeding and/or sleeping problems still had more problems of this kind compared with the reference children. Early child health problems were more frequent within the clinical group, but recent health problems did not separate the two groups. Mothers in the clinical sample reported more health problems than mothers in the reference group and clinical parents were less content with their social support and had more psychosocial problems, including stressful life events. Children in the clinical sample had more internalizing problems than comparison children. Recent feeding and sleeping problems were connected to more externalizing and internalizing problems. Conclusions Early regulatory problems, concerning sleeping or feeding, are less frequent when the child grows up, but nevertheless tend to remain. A clinical recommendation for child health care is to take both child and family factors into account, to individualize contacts, work with an all‐inclusive perspective and have close follow‐ups.     

Internalizing problems in a sample of Romanian preschool children. Contributions of both child and maternal temperament along with family functioning

ABSTRACT

Internalizing problems are among the most common chronic psychological dysfunctions in childhood, yet the factors contributing to their emergence and persistence in preschool-aged children are still less understood. The contribution of specific individual variables (e.g. temperament), and that of proximal environmental factors, such as family environment, recently gained attention. The present study investigated the joint contributions of child and maternal temperament (specifically, Negative Affectivity and Effortful Control), respectively family functioning, to the development of internalizing problems in a sample of 50 Romanian preschoolers. We assessed these variables of interest with maternal reports. Both child Negative Affectivity and Effortful Control significantly contributed to internalizing problems. Maternal temperamental factors moderated the relation between child Effortful Control and internalizing problems. Maladaptive family functioning appeared to be a partial mediator of the relation between maternal Negative Affectivity and child internalizing behaviours.     

Influence of Play and Temperament on the Young Child's Response to Pain

The relation between the adjustment of children treated for hypothalamic/chiasmatic brain tumors and family functioning was examined. Participants were 29 children, ages 7 to 17 years, who were off treatment at least 6 months, and their mothers and fathers. Child adjustment was compared with 29 same-age survivors of other brain tumors and a normative sample. Results support the presence of increased behavior problems and decreased social and academic competence in these particular brain tumor survivors compared with the normative sample. They did not differ significantly from other brain tumor survivors based on mother ratings. Decreased competence and increased emotional and behavioral problems were related significantly to child, mother, and father reports of poorer family functioning. Older age at diagnosis, less perceived change in child due to tumor and treatment, and regular education placement were related to higher child competence and better behavior but not to family functioning. These findings highlight the need for working with families to provide resources and skills in dealing with the social and behavioral changes that result from brain tumors and their treatment.     

The Impact of Childhood Hypothalamic/Chiasmatic Brain Tumors on Child Adjustment and Family Functioning

The relation between the adjustment of children treated for hypothalamic/chiasmatic brain tumors and family functioning was examined. Participants were 29 children, ages 7 to 17 years, who were off treatment at least 6 months, and their mothers and fathers. Child adjustment was compared with 29 same-age survivors of other brain tumors and a normative sample. Results support the presence of increased behavior problems and decreased social and academic competence in these particular brain tumor survivors compared with the normative sample. They did not differ significantly from other brain tumor survivors based on mother ratings. Decreased competence and increased emotional and behavioral problems were related significantly to child, mother, and father reports of poorer family functioning. Older age at diagnosis, less perceived change in child due to tumor and treatment, and regular education placement were related to higher child competence and better behavior but not to family functioning. These findings highlight the need for working with families to provide resources and skills in dealing with the social and behavioral changes that result from brain tumors and their treatment.     

Problem Solving and Adjustment in Families of Children With Diabetes

Communication and problem-solving skills in families of children with diabetes (n'= 20) and families of healthy children (n = 20) were compared. Families completed paper-pencil measures and engaged in simulated problem-solving situations while being videotaped. In terms of raw behavior frequencies, diabetes families talked less than comparison families and used less of some problem solving skills. When overall verbosity was controlled for, however, fewer differences emerged in terms of problem-solving and communication skills. For diabetes families, significant relationships were found among behavior, adjustment, and illness variables. The importance of understanding the specific influence of diabetes-related stress on family functioning is discussed.     

Problem Solving and Adjustment in Families of Children With Diabetes

Communication and problem-solving skills in families of children with diabetes (n'= 20) and families of healthy children (n = 20) were compared. Families completed paper-pencil measures and engaged in simulated problem-solving situations while being videotaped. In terms of raw behavior frequencies, diabetes families talked less than comparison families and used less of some problem solving skills. When overall verbosity was controlled for, however, fewer differences emerged in terms of problem-solving and communication skills. For diabetes families, significant relationships were found among behavior, adjustment, and illness variables. The importance of understanding the specific influence of diabetes-related stress on family functioning is discussed.     

Children With Primary Immunodeficiency Disorders: Family Functioning, Coping Strategies, and Behavioral Functioning

This study examined the psychosocial functioning of children with primary immunodeficiency disorders (PIDD), an underresearched chronic illness sample. Children with PIDD were compared to children with kidney disease and to a healthy comparison group. Participants were youth ages 8 to 21 years. Children and caregivers each completed measures on family functioning, behavioral adjustment, and coping strategies. Significant group differences were obtained for child report of family functioning. Regression results indicated that caregiver report of family roles and affective responsiveness, as well as child report of family communication, were significantly involved in predicting child behavioral functioning. Family functioning does appear to be related to child behavioral functioning in children with PIDD.     

Temperament,parental personality and parenting stress in relation to socio-emotional development at 51 months

ABSTRACT

This study examined the relevance of infant temperament, parent personality and parenting stress for children’s socio-emotional development, looking in addition for any differences between mothers and fathers. Participants, from a community sample, were 410 mothers and fathers reporting their personality (NEO Personality Inventory), child temperament in the first (Infant Characteristics Questionnaire) and second (Toddler Behavior Assessment Questionnaire) years, parenting stress to 36 months (Parenting Stress Index Short Form) and child behaviour at 51 months (Strengths and Difficulties Questionnaire). Difficult toddler temperament was associated with more externalizing and internalizing problems. Higher paternal extraversion was associated with more prosocial behaviour whereas lower maternal extraversion was associated with more internalizing problems. For both parents, describing a dysfunctional parent–child relationship was related to more externalizing problems and to less prosocial behaviour, for fathers also to more internalizing problems, which associated for mothers with more parental distress.     

The Psychosocial Adjustment of Well Siblings of Chronically Ill Children

This exploratory study examined the psychosocial adjustment of 19 siblings of chronically ill children (termed well siblings) in comparison to 19 siblings of healthy children. Results indicated no differences between the psychosocial adjustment of siblings in each group. Results of within-sibling group correlations suggested that when well siblings experienced adjustment problems, some of their problems were related to family structure characteristics, child characteristics, and parenting. Nonetheless, few differences were found in children's psychosocial adjustment across sibling groups as a function of family structure characteristics, child characteristics, and parenting. Implications for identifying well siblings who may be in greatest need of psychosocial care as well as the goals of psychosocial care are discussed.     

Effects of parental perception of neighbourhood deprivation and family environment characteristics on pro‐social behaviours among 4–12 year old children

Objective: To assess the effect family environment stressors (e.g. poor family functioning and parental psychological distress) and neighbourhood environment on child prosocial behaviour (CPB) and child difficulty behaviour (CDB) among 4‐to‐12 year old children. Methods: Analysis of the 2006 Victorian Child Health and Wellbeing Survey (VCHWS) dataset derived from a statewide cross‐sectional telephone survey, with a final total sample of 3,370 children. Results: Only family functioning, parental psychological distress, child gender, and age were associated with CPB, explaining a total of 8% of the variance. Children from healthily functioning families and of parents without any psychological distress exhibited greater prosocial behaviours than those from poorly functioning families and of parents with mental health problems. Neighbourhood environment was not found to contribute to CPB. A total of eight variables were found to predict CDB, explaining a total of 16% of the variance. Poor family and parental psychological functioning as well as poor access to public facilities in the neighbourhood were associated with conduct problems in children. Conclusion: Our results point to the importance of the family environment in providing a context that fosters the development of empathic, caring and responsible children; and in buffering children in exhibiting behaviour difficulties during the formative years of life. Programs aimed at promoting prosocial behaviours in children need to target stressors on the family environment.     

The Psychosocial Adjustment of Well Siblings of Chronically Ill Children

This exploratory study examined the psychosocial adjustment of 19 siblings of chronically ill children (termed well siblings) in comparison to 19 siblings of healthy children. Results indicated no differences between the psychosocial adjustment of siblings in each group. Results of within-sibling group correlations suggested that when well siblings experienced adjustment problems, some of their problems were related to family structure characteristics, child characteristics, and parenting. Nonetheless, few differences were found in children's psychosocial adjustment across sibling groups as a function of family structure characteristics, child characteristics, and parenting. Implications for identifying well siblings who may be in greatest need of psychosocial care as well as the goals of psychosocial care are discussed.     

Effects of cumulative risk on behavioral and psychological well-being in first grade: Moderation by neighborhood context

This study builds upon existing research by examining whether risk indices for child psychological well-being behave in the same way in different types of neighborhoods. Specifically, we sought to determine if neighborhood characteristics acted to exacerbate or, alternatively, to buffer risk factors at the family and/or child level. Families with a child entering first grade in Fall 2002 were recruited from Baltimore City neighborhoods, defined as census block groups. This study included 405 children, and data came from an interview with the primary caregiver and an assessment of the first grader. The dependent variables were externalizing behavior and internalizing problems. A family risk index consisting of 13 measures, and a child risk index consisting of three measures were the main independent variables of interest. We examined the effects of these indices on child psychological well-being and behavior across two neighborhood characteristics: neighborhood potential for community involvement with children and neighborhood negative social climate. Results of multivariate analyses indicated that cumulative family risk was associated with an increase in both internalizing and externalizing behavior problems. Perceived negative social climate moderated the effect of family risks on behavior problems such that more risk was associated with a larger increment in both externalizing behavior problems and psychological problems for children living in high versus low risk neighborhoods. These findings further emphasize the importance of considering neighborhood context in the study of child psychological well-being.     

Social Functioning, Peer Relations, and Internalizing and Externalizing Problems Among Youths With Sickle Cell Disease

This study examined differences in social functioning, peer relations, internalizing behaviors, and externalizing behaviors between youths (ages 4-18) with sickle cell disease (SCD) and demographically matched healthy peers using parent-, teacher-, and youth-report versions of the Child Behavior Checklist and Missouri Peer Relations Inventory. Youths with SCD were reported by themselves to have more social and externalizing problems compared to healthy peers. Moreover, a significantly greater percentage of youths with SCD had borderline and clinical levels of social, internalizing, and externalizing problems relative to the healthy comparison group, Illness severity variables were not associated with any of the dependent measures. Overall, although the social functioning of youths with SCD is perceived by parents and teachers to be adequate, adolescents with SCD view themselves as having more.     

Attendance Patterns and Links to Non-Response on Child Report of Internalizing among Mexican-Americans Randomized to a Universal Preventive Intervention

We examined attendance trajectory profiles among 335 Mexican-American families participating in an 11-week universal intervention to explore if heterogeneity in attendance and thus dosage was associated with intervention response, defined as pre-to-2-year post (T2) reductions in child report of internalizing symptoms. We estimated trajectories accounting for the influence of baseline covariates, selected based on the Health Belief Model (HBM) and Latino family research, to understand covariate associations with trajectories. Results supported six attendance trajectory groups: non-attenders (NA), early dropouts-low internalizing (EDO-LI), early dropouts-high internalizing (EDO-HI), mid-program dropouts (MPDO), sustained attenders-low internalizing (SA-LI), and sustained attenders-high internalizing (SA-HI). All groups except EDO-HI showed significant pre-to-post change on child report of internalizing; however, trajectory groups reflecting more attendance did not have greater pre-to-post change. Nonetheless, child report of internalizing differentiated two subgroups of sustained attenders and two subgroups of early dropouts. These results suggest heterogeneity among families with similar patterns of attendance and highlight the importance of modeling this heterogeneity. Although life stress was a barrier to participation, there was minimal support for the HBM. Cultural influences, acculturation, and familism, played a more prominent role in distinguishing trajectories. As expected, the EDO-HI group was less acculturated than both sustained attender groups and reported weaker familism values than the SA-HI group. However, unexpectedly, the SA-LI group had lower familism than the EDO-LI group. The results suggest that the influence of culture on participation is nuanced and may depend on child symptomatology.

     

Attendance Patterns and Links to Non-Response on Child Report of Internalizing among Mexican-Americans Randomized to a Universal Preventive Intervention

We examined attendance trajectory profiles among 335 Mexican-American families participating in an 11-week universal intervention to explore if heterogeneity in attendance and thus dosage was associated with intervention response, defined as pre-to-2-year post (T2) reductions in child report of internalizing symptoms. We estimated trajectories accounting for the influence of baseline covariates, selected based on the Health Belief Model (HBM) and Latino family research, to understand covariate associations with trajectories. Results supported six attendance trajectory groups: non-attenders (NA), early dropouts-low internalizing (EDO-LI), early dropouts-high internalizing (EDO-HI), mid-program dropouts (MPDO), sustained attenders-low internalizing (SA-LI), and sustained attenders-high internalizing (SA-HI). All groups except EDO-HI showed significant pre-to-post change on child report of internalizing; however, trajectory groups reflecting more attendance did not have greater pre-to-post change. Nonetheless, child report of internalizing differentiated two subgroups of sustained attenders and two subgroups of early dropouts. These results suggest heterogeneity among families with similar patterns of attendance and highlight the importance of modeling this heterogeneity. Although life stress was a barrier to participation, there was minimal support for the HBM. Cultural influences, acculturation, and familism, played a more prominent role in distinguishing trajectories. As expected, the EDO-HI group was less acculturated than both sustained attender groups and reported weaker familism values than the SA-HI group. However, unexpectedly, the SA-LI group had lower familism than the EDO-LI group. The results suggest that the influence of culture on participation is nuanced and may depend on child symptomatology.     

Low-Level Symptoms of Depression in Mothers of Young Children are Associated with Behavior Problems in Middle Childhood

Objectives Examine the association between mothers’ low- and high-level depressive symptoms in early childhood and children’s behavior problems in middle childhood. Methods We used data from 1844 families in a multi-site, longitudinal study beginning when children were 14 months and continuing to age 11 years. Children’s internalizing and externalizing behavior problems at age 11 were assessed using the child behavior checklist for ages 6–18. Mothers’ scores on the Center for Epidemiological Studies-Depression Scale when children were 14 months were used to classify them into three groups: ‘no depressive symptoms’, ‘low-level depressive symptoms (below the clinical cut-off)’ and ‘clinically significant depressive symptoms (above the clinical cut-off).’ Results Mothers were racially/ethnically diverse, including Caucasian (38.9 %), African-American (34.4 %), Hispanic (21.6 %), or other (5.1 %). More than one-third (39.2 %) were teenaged mothers, and 46.0 % did not complete high school. Of the 1844 families, 1172 had age 11 child outcome data. Logistic regression analyses controlling for family demographics revealed a significant association between early maternal depressive symptoms and later child behavioral outcomes. Both low level and clinically significant symptoms were associated with internalizing and externalizing behavior problems. For example, children whose mothers had low-level depressive symptoms were twice as likely to have clinically elevated internalizing problems compared with children whose mothers never had symptoms of depression. Conclusions Children whose mothers experience low-level depressive symptoms early in their development have increased risk for later behavioral problems, suggesting a possible need for new screening and intervention strategies for mothers with lower than clinically elevated symptoms.     

The effects of house moves during early childhood on child mental health at age 9 years

ABSTRACT: BACKGROUND: Residential mobility is common in families with young children; however, its impact on the social development of children is unclear. We examined associations between the number, timing and type of house moves in childhood and child behaviour problems using data from an ongoing longitudinal study. METHODS: Complete data on residential mobility and child behaviour was available for 403 families. Three aspects of mobility were considered: (a) number of house moves from birth to <2 years, 2 to <5 years and 5 to 9 years; (b) lifetime number of house moves; and (c) moves associated with different housing trajectories characterized by changes in housing tenure. The primary outcomes were internalizing and externalizing behaviour problems at 9 years derived from Achenbach's Child Behaviour Checklist. Linear regression analyses were used to investigate the effect of the housing variables on internalizing and externalizing behaviour problem scores with adjustment for a range of sociodemographic and household covariates. RESULTS: Moving house 2 or more times before 2 years of age was associated with an increased internalizing behaviour score at age 9 years. This association remained after adjustment for sociodemographic and household factors. There was no association between increased residential mobility in other time periods and internalizing behaviour, or mobility in any period and externalizing behaviour. There was no effect of lifetime number of moves, or of an upwardly or downwardly mobile housing trajectory. However, a housing trajectory characterized by continuous rental occupancy was associated with an increased externalizing behaviour score. CONCLUSIONS: These findings may suggest that there is a sensitive period, in the first few years of life, in which exposure to increased residential mobility has a detrimental effect on mental health in later childhood.     

An Examination of Parenting Capacity Variables and Child Adjustment Outcomes Across Socioeconomic Level in Pediatric Cancer

The objective of this article is to investigate how parenting capacities and child outcomes vary across different indexes of socioeconomic status (SES; e.g., composite vs. single dimension) in a sample of families of children with pediatric cancer. Parents provided demographic information for the Hollingshead Index of Social Position, the Parent Protection Scale (PPS), the Child Vulnerability Scale (CVS), the Parenting Stress Index/Short Form (PSI/SF), and the Behavior Assessment System for Children–Second Edition, Parent Rating Scale. Only the PPS differed by composite social status on the Hollingshead Index. Both the PPS and the PSI/SF varied as a function of lower parent education and family income, whereas the CVS was impacted only by lower parent education level. Child externalizing and internalizing problems were influenced only by lower family income. Results highlight the variability in parent and child adjustment outcomes based on the manner in which SES is measured in families of children with cancer.     

Parenting Satisfaction and Efficacy Among Caregivers of Children With Diabetes

This study assessed parenting satisfaction and efficacy in 53 parents of children with diabetes and 39 parents of physically healthy children. In addition, the relationship between parenting self-esteem and perceptions of child behavior, child age, disease duration, and metabolic control were examined. Parents of children with diabetes reported significantly lower levels of parenting satisfaction and efficacy compared to parents of healthy children, and their negative parental cognitions are most influenced by perceptions of more internalizing child problems, shorter diabetes duration, and poorer metabolic control. Parenting self-esteem was significantly inversely correlated with both internalizing and externalizing child behavior problems for patents of healthy children. The clinical implications of poor parental cognitions and directions for future research are highlighted.