Studying the "referability" of child clinical problems

Child clinical problems may differ in their power to evoke clinic referral, and this "referability" of problems may also differ with the gender or culture of the child who manifests them. The authors propose (a) a method for the study of such differences and (b) a new statistic, the referability index (RI). RI reflects the frequency with which a child problem stimulates clinic referral, adjusted for its prevalence in the general population. RI was assessed across 118 child problems as a function of problem type (overcontrolled vs. undercontrolled), child gender, and culture (U.S. vs. Thailand). Problems of both types were more referable in girls than boys: undercontrolled problems were more referable than overcontrolled in the U.S. but, surprisingly, not in Thailand. The findings shed new light on gender and culture differences and illustrate the empirical and heuristic potential of the RI statistic.     

Jamaican and American adult perspectives on child psychopathology: further exploration of the threshold model.

Although several factors determine whether children receive psychological intervention, cultural determinants may be particularly influential. Cultural factors may influence adults' levels of concern over child psychopathology. This possibility was explored by comparing adult attitudes in two socioculturally different societies. Jamaican and American parents, teachers, and clinicians (total N = 382) judged vignettes of two children, one with overcontrolled (e.g., fearfulness) and one with undercontrolled (e.g., fighting) problems. Regression analyses revealed that although years of education affected some adult ratings, culture had the most profound effect.     

The effects of race and problem type on teachers' assessments of student behavior

The authors tested the hypothesis that race bias in teacher evaluations may be problem specific by examining the extent to which ratings of child behavior were influenced by the interaction between the race of the child and the type of presenting behavior. Teachers (N = 197) were presented with three vignettes (overcontrolled, undercontrolled, and "normal"), systematically paired with a photograph of a male child (African American, Asian American, or Caucasian). Respondents rated the seriousness, referability, and typicality of the behavior; the child's family life; academic ability and performance; and causal dimensions. Although results did not reveal a bias in the ratings of African American students, data suggest that stereotypes remain embedded in teachers' interpretive framework for Asian Americans, particularly regarding expectations of overcontrolled traits.     

The impact of classroom aggression on the development of aggressive behavior problems in children

Prior research suggests that exposure to elementary classrooms characterized by high levels of student aggression may contribute to the development of child aggressive behavior problems. To explore this process in more detail, this study followed a longitudinal sample of 4,907 children and examined demographic factors associated with exposure to high-aggression classrooms, including school context factors (school size, student poverty levels, and rural vs. urban location) and child ethnicity (African American, European American). The developmental impact of different temporal patterns of exposure (e.g., primacy, recency, chronicity) to high-aggression classrooms was evaluated on child aggression. Analyses revealed that African American children attending large, urban schools that served socioeconomically disadvantaged students were more likely than other students to be exposed to high-aggressive classroom contexts. Hierarchical regressions demonstrated cumulative effects for temporal exposure, whereby children with multiple years of exposure showed higher levels of aggressive behavior after 3 years than children with primacy, less recent, and less chronic exposure, controlling for initial levels of aggression. Implications are discussed for developmental research and preventive interventions.     

Developmental foundations of externalizing problems in young children: the role of effortful control

Examined associations between effortful control temperament and externalizing problems in 220 3-year-old boys and girls, controlling for co-occurring cognitive and social risk factors. We also considered possible additive and/or interactive contributions of child dispositional anger and psychosocial adversity, and whether relations between effortful control and early externalizing problems were moderated by child gender. Individual differences in children's effortful control abilities, assessed using behavioral and parent rating measures, were negatively associated with child externalizing problems reported by mothers, fathers, and preschool teachers. These associations were not overshadowed by other cognitive or social risk factors, or by other relevant child temperament traits such as proneness to irritability. Further analyses revealed that associations between externalizing problem behavior and effortful control were specific to components of child problem behavior indexing impulsive-inattentive symptoms. Thus, children's effortful control skills were important correlates of children's early disruptive behavior, a finding that may provide insight into the developmental origins of chronic behavioral maladjustment.     

Effect of Co-Occurrence on the Referability of Internalizing and Externalizing Problem Behavior in Adolescents

Assessed the effect of co-occurring versus not co-occurring internalizing and externalizing behavior problems on the reasons parents reported for clinical referral of their adolescent child. Reasons for referral were coded for 181 inpatient adolescents, and parent ratings of internalizing and externalizing behavior were obtained for a general population sample of 500 adolescents. Parents concurrently reported internalizing and externalizing behavior as reasons for referral less frequently (p < .0001) than would be expected given the correlation between these two domains in the general population sample. This suggests that the presence of externalizing problems may decrease parents' concern or awareness of internalizing problems, the presence of internalizing problems may decrease parents' concern or awareness of externalizing problems, or both Implications for the clinical referral of adolescents and for informal parental efforts at helping their children with externalizing and internalizing problems are discussed.     

Correlates of clinic referral for early conduct problems: variable- and person-oriented approaches

The current study utilized both variable- and person-oriented analyses to examine correlates of early disruptive behavior problems. Participants included 80 preschool boys referred to a child psychiatry clinic and diagnosed with oppositional defiant disorder (with or without attention-deficit hyperactivity disorder) and 80 case-matched normal comparison boys. The study examined four domains of correlates: vulnerable child characteristics, poor parenting practices, insecure attachment, and adverse family ecology. Results indicated that the combination of these factors provided relatively high sensitivity (81%) and specificity (85%), clearly differentiating referred from comparison boys. A dramatic increase in clinic status occurred when three or more factors were present, and specific combinations of factors were differentially predictive of conduct problems. However, no correlates were found to be either necessary or sufficient for clinic status. By maintaining the integrity of individual cases, person-oriented analyses were able to answer different questions than more traditional variable-oriented analyses. Discussion focuses on the value of person-oriented analyses for understanding heterogeneous clinical groups.     

Adopted children's behavior problems: a review of five explanatory models

Although the majority of adopted children are well-adjusted, adopted children evidence proportionately more behavior problems when compared to nonadopted children in both clinic and nonclinic populations. An extensive literature examining behavioral, diagnostic, and demographic characteristics of adopted children has provided several plausible explanations for the high rate of behavior problems among adopted children. In this review, the existing literature is organized into five explanatory models: (a) genetic or "biosocial" factors, (b) pathogenesis of the adoption process, (c) long-term effects of impaired preadoption childrearing, (d) referral bias in adoptive parents, and (e) impaired adoptive parent-adoptee relations. We conclude that evidence for each model is mixed at best. Especially noteworthy is the mixed results for genetic or biosocial studies and the relative absence of studies focused on identifying factors associated with disruptions in the adoptive parent-adoptee relationship. We propose that a psychosocial model to explain the high rate of behavior problems among adopted children is highly plausible and further suggest that it may be time for a new awareness and appreciation for the normative aspects of adoption. An overview of parenting and family characteristics associated with risk factors for antisocial behavior is provided as a guide for future research.     

Determination of HLA class II alleles by genotyping in a Manchu population in the northern part of China and its relationship with Han and Japanese populations

Abstract: To investigate the genetic background of the black populations of Colombia and Jamaica, we determined HLA types of 78 Colombian and 98 Jamaican blacks from 2 different socioeconomic groups (Jamaican #1 and Jamaican #2) and estimated the frequencies of HLA genes and haplotypes. A phylogenetic tree based on the HLA gene frequencies revealed that Jamaican #1 and Jamaican #2 were distinct from each other, Jamaican #1 being closely related to the Colombian blacks and the Jamaican #2 being closely related to Senegalese and Zairean populations. Three-locus HLA haplotypes of Colombian and Jamaican #1 blacks were an admixture between Africans and Caucasians or South American Indians, while Jamaican #2 blacks were relatively homogeneous and appeared to conserve African lineages. The major five-locus HLA haplotypes were not shared among Colombian, Jamaican #1 and Jamaican #2 blacks. These results indicated that the black populations of Colombia and Jamaica were originated from African blacks and admixed variably with Caucasians and South American Indians to make genetic subpopulations in Colombia and Jamaica.     

The role of culture in moderating the links between early ecological risk and young children's adaptation

To examine the effects of risk on infant development within cultural contexts, 141 dual-earner Israeli and Palestinian couples and their first-born child were observed at 5 months and again at 34 months. Eight ecological determinants were examined as potential risk factors, including the infant's observed and parent-reported difficult temperament; the mother's depressive symptoms, work-family interference, and experience of childbirth; the parents' marital satisfaction and social support; and observed maternal and paternal sensitivity. Symbolic play and behavior problems were assessed at 34 months. Culture-specific effects of risk and protective factors were found. Parent sensitivity facilitated symbolic competence to a greater extent in the Israeli group. Culture moderated the effects of maternal depression and family social support on toddlers' behavior problems. Maternal depressive symptoms had a negative impact on the behavior adaptation of Israeli children and social support buffered against behavior problems in the Arab group. Implications for research on risk and resilience and the role of culture in moderating the effects of ecological risk are discussed.     

Cultural factors in help‐seeking for child behavior problems: Value orientation,affective responding,and severity appraisals among Chinese‐American parents

This study explored the relationships between cultural values, appraisal of child behavior problems, and associated help‐seeking intentions among Chinese‐American parents. Questionnaires were administered to 120 Chinese‐American parents of elementary‐school‐aged children. Parents were asked how they might respond if their child displayed the behavioral problems depicted in a hypothetical vignette. Influences of Chinese value orientation, severity appraisal, and affective reactions on help‐seeking intentions were examined using regression analyses and structural equation modeling. The study examined three hypotheses regarding the nature of the influence of cultural value orientation on help‐seeking intentions: (a) a direct effect model, (b) an indirect effect through cultural differences in severity appraisal, and (c) an indirect effect through cultural differences in affective responding. Results supported the hypothesis that cultural value orientation exerted an indirect effect on help‐seeking intentions through its influence on affective responding. Those parents who had more traditional Chinese values responded with more feelings of shame to child behavior problems and, in turn, reported lower intentions to seek help. Findings are discussed with reference to the literature on help‐seeking among Asian Americans. © 2001 John Wiley & Sons, Inc.     

Transient versus stable behavior problems in a normative sample: infancy to school age.

Identified 3 subgroups of children from a prospective longitudinal study of temperament and development: (a) those with stable, (b) transient, or (c) no-behavior problems, as rated by mothers across the toddler, preschool, and preparatory school grade periods. Children with stable behavior problems were particularly characterized by more difficult temperament, mothers' overall perception of the child as difficult, and aggressive behavior in the 2- to 4-year age period. Group differences were linear rather than categorical with transient behavior problem children showing a lesser degree of difficulty. In a second study where more comprehensive child and family measures were available, temperament was again an important discriminator, with Vineland Adaptive Behavior Composite Score, mothers' overall perception of the child's temperament, and maternal psychological health and stress factors also more adverse for the stable group. However, correct classification of the members of these groups using a combination of the above variables was not impressive.     

Diagnosis and childhood firesetting

This paper presents findings on the relationship of childhood firesetting and DSM-III diagnosis in a representative sample of child psychiatric outpatients (N = 204). Childhood firesetting and the DSM-III diagnosis of conduct disorder are strongly related; they show a significant interaction effect with lessened competence as measured by activities and increased externalizing (undercontrolled) behavior.     

Behavioral adjustment of latency age children with cystic fibrosis

One hundred and twenty-six 6 to 11-year-old latency age children with Cystic Fibrosis regularly attending the CF clinic of the Hospital for Sick Children were asked to complete the Piers-Harris Self-Concept Scale and the Children's Health Locus of Control. Their parents were requested to complete the Child Behavior Checklist and the Family Assessment Measure. One hundred and eight (86%) participated in the study. Twenty-three percent of the children were found to have sufficient behavior problems to indicate a significant degree of maladjustment. Latency-age CF children show an increase in problems compared to a pre-school group, suggesting that leaving the protection of the family is problematic for a child with a chronic physical disorder. Males show more behavior problems than females. Males' behavior is characterized by somatic complaint profile. In spite of difficulties, CF latency children are able to maintain good social competence and self-concept suggesting compensatory mechanisms. These mechanisms are different for males and females. Females' self-concept and social competence are supportive of each other, whereas for males, this is not the case. Similarly, female behavior is relevant to family functioning. Males and females adjust to difficulty as indicated by differences in behavior profiles.     

Parenting Styles and Child Behavior in African American Families of Preschool Children

Examined the relations between parenting styles and child behavior problems in African American preschool children. Participants were 108 African American female caregivers of 3- to 6-year-old children. Correlational analysis showed that parent-reported child behavior problems were associated with maternal education, family income, and parents' endorsement of authoritative parenting, authoritarian parenting, and permissive parenting. Hierarchical regression analysis showed that the authoritative parenting style was most predictive of fewer child behavior problems. These results are consistent with previous findings with European American families and provide strong support for the cross-cultural validity of the authoritative parenting style.     

Attachment in boys with early onset conduct problems

Few studies have examined the association between attachment and psychopathology in samples of clinically diagnosed children or the relation between attachment variables and the continuity of clinical symptoms. Clinic-referred preschool boys (n = 80) with early onset conduct problems (as indicated by diagnoses of Oppositional Defiant Disorder) were compared with a case-matched group of 80 nonproblem boys to determine whether observed attachment behaviors could: (a) differentiate the groups, (b) explain concurrent variation in problem severity within the clinic group, and (c) predict the outcomes of clinic boys 1 and 2 years later. Over half of the clinic boys with early onset conduct problems (54%) exhibited an insecure attachment strategy during reunion, as opposed to 18% of comparison group boys. All insecure patterns were overrepresented in the clinic group. Clinic boys were more likely than comparison boys to engage in provocative behavior when separated from their mothers. Contrary to our hypothesis, attachment variables showed little ability to explain concurrent or future variation in the problem severity or diagnostic status of clinic boys. We conclude that observable attachment behaviors exhibited during the preschool years are related to the initial identification of early onset conduct problems but may have little value by themselves in predicting the subsequent course and severity of problems in the 2 years following clinic referral.     

Developmental Differences in Primary and Secondary Control Coping and Adjustment to Juvenile Diabetes

Compared diabetic youngsters at two levels of cognitive maturity to explore developmental differences in relations between child characteristics and adjustment. Differences in coping style and in pattern of relationships emerged between formal operational and pre-formal groups. For example, knowledge about diabetes was positively related to medical adjustment for the formal but not the pre-formal children. Although all child characteristics were related to one or more adjustment measures, no relationship between a child variable and an adjustment measure replicated across the two cognitive level groups. The findings suggest that a develop. mental perspective may help refine our understanding of children's adaptation to chronic illness.     

Examining the association between parenting and childhood depression: a meta-analysis

Theoretical models posit that parenting plays a causal role in the development and maintenance of child psychological problems, yet meta-analytic findings indicate that parenting accounts for less than 6% of the variance in child externalizing problems and less than 4% of the variance in childhood anxiety. Extending the analysis to childhood depression, we conducted a meta-analysis of 45 studies testing the association between parenting and childhood depression. We found that parenting accounted for 8% of the variance in child depression. Parental rejection was more strongly related to childhood depression than was parental control. Moreover, various subdimensions of parenting were differentially associated with childhood depression, with parental hostility toward the child most strongly related to child depression. Analyses also revealed that methodological factors (i.e., how parenting and child depression was conceptualized and assessed) moderated the parenting-childhood depression association. Inconsistent findings within the literature are partially attributable to variations from study to study in measurement quality. Closer attention to the precise measurement of these two constructs in future studies may lead to a more accurate estimate of the association between parenting and child depression. In all, the modest association between parenting and childhood depression indicates that factors other than parenting may account for the preponderance of variance in childhood depression.     

Factors affecting the link between physical discipline and child externalizing problems in Black and White families

We examined contextual factors that may affect the impact of physical discipline on later child behavior problems among high‐risk Black and White families. We examined race, parental warmth, and early child problems as potential moderators of the discipline–behavior problem link. The sample included 442 White and Black children and their caregivers interviewed at ages 4, 6, and 8 years. Results indicated that physical discipline operated similarly across the groups, leading to increased externalizing problems only when children demonstrated behavioral problems early on. However, while warm parental attitudes protected against later problems among White children, these attitudes exacerbated early problems in Black children. These findings suggest both racial variability and generalizability in the effects of parenting on child adjustment. © 2006 Wiley Periodicals, Inc.     

Cultural issues in the treatment of young African American children diagnosed with disruptive behavior disorders

OBJECTIVE: To discuss issues relevant to treating young African American children with disruptive behavior disorders. METHOD: We treat behavior disorders, correlates of behavior disorders, and special differences between African American and Caucasian children that could lead to or explain behavior problems. DISCUSSION: The majority of the information on young children diagnosed with disruptive behavior disorders has been obtained primarily from Caucasian children and families. Unfortunately, this reliance on Caucasian data neglects the unique needs of minorities and may lessen the quality of the services that they receive. Omission of ethnic concerns becomes even more salient with the increasing ethnic diversity among children and families in the United States. CONCLUSIONS: We suggest future research and clinical directions that will ultimately assist clinicians to provide high-quality mental health services to African American children.