The effect of maternal depression and marital adjustment on young children's internalizing and externalizing behaviour problems

BACKGROUND: The present study aimed to clarify the circumstances under which maternal depression is associated with adverse outcomes in pre-school-aged children, and to explore the additional impact of the marital relationship in a socio-economically low-risk sample. METHODS: Ninety-two mothers recruited into a longitudinal study were assessed for symptoms of depression when their children were 4, 12 and 15 months, and later at 4 years of age. At 4 years of age, mothers were also asked to report on marital adjustment. Mothers, fathers and pre-school teachers were asked to report on children's internalizing and externalizing behaviour problems. RESULTS: Children exposed to chronic maternal depression were rated by their parents as significantly more problematic on internalizing and externalizing behaviours. This association was not mediated or moderated by low marital satisfaction. No parent-reported effects were evident for children exposed to transient depression. Ten per cent of the children had internalizing scores in the clinical range, and 7% had externalizing scores in the clinical range. Almost all of the children with clinically elevated scores had been exposed to chronic maternal depression. Teacher reports of internalizing behaviours corroborated parent reports; however, teachers tended to report significantly lower levels of behaviour problems. Although there was a tendency for teachers to rate children exposed to any depression as more problematic on internalizing behaviours, the subgroup differences were not significant. CONCLUSIONS: Findings confirm that depression chronicity is important in determining child behavioural outcomes, and that depression effects cannot be accounted for by low marital adjustment. Results are discussed with reference to transmission of risk models, and treatment implications are considered.     

Variation in children's cognitive and behavioural adjustment between different types of place in the British National Child Development Study

Several recent studies suggest that there is a link between children's development and the types of neighbourhood in which they live. This paper examines the relationship of a classification of different types of neighbourhood to children's cognitive and behavioural outcomes using British data on children who have a parent who is a member of the 1958 Birth Cohort Study. Substantial variations in children's outcomes were observed between the neighbourhood types. Part of the variation between neighbourhood types was accounted for by various family risk factors but children living in neighbourhoods classified as Deprived City Areas continued to have higher levels of behaviour problems and lower cognitive test scores than average after adjustment for these factors. Significant adjusted associations were also found between living in neighbourhoods described as Middling Britain and lower cognitive test scores and neighbourhoods described as Prosperous Areas and better cognitive test scores. For children's cognitive outcomes, both the size and statistical significance of coefficients on the neighbourhood categories were smaller than those of family-level measures. In contrast, residence in a Deprived City Area was as significant as the family factors in predicting higher levels of behaviour problems. The association between behaviour problems and family risk factors was mediated by the home environment and cohort member parent's psychological health. Mediated effects were stronger for the family risk factors behavioural problems association than for the neighbourhood classification.     

Enquiry about the needs of children whose mothers are admitted to psychiatric hospitals

The objective of this study is to assess whether children's needs are taken into consideration in female patients who are admitted to an adult psychiatric hospital. A retrospective case note audit of 100 female inpatients aged between 18 and 55 years over a 6-month period were randomly selected. The medical and nursing case notes of patients with children aged between 0 and 17 were assessed using a proforma. The information collected on mothers consisted of diagnosis of illness, type of admission (whether voluntary or detained), duration of admission, previous psychiatric admissions, patient age, marital status, whether or not employed, relationship with partner, mental health of partner, history of violence, medical history of relevance, family history of mental illness, and whether other agencies were involved. Children data collected consisted of number of children per patient and their ages, an enquiry into the child's welfare, emotional and behavioural development, educational/cognitive development, physical health and development, relationship with family and peers, children's knowledge of parent's illness, alternative care arrangements for child during mother's admission and their relationship to carer, child's involvement in their parents' illness as a carer and actions taken on behalf of the child. Of the 100 patients, 62 had children aged between 0 and 17 years. There was an enquiry into children's welfare in 15 (24%) cases and an enquiry into children's knowledge of their parents' illness in three (4.8%). Actions were taken on behalf of children in 13 (21%) cases, in five cases this was not necessary as children resided elsewhere, and in one case a social work assessment was requested but no subsequent documentation of this being completed. There was no documentation of actions taken in the remaining 43 (69.4%) cases. The results of this retrospective case note audit suggest that children's welfare is not routinely enquired about in female patients admitted to psychiatric hospitals. Actions taken on behalf of children occurred often when there was social services involvement. As a result of this study guidance was issued to all new junior psychiatric staff as part of their induction process to make enquiries about children and their welfare.     

Parents’ attitudes towards their children with cerebral palsy

A negative attitude towards disability from family not only impacts upon a child directly, but also adds to the existing stress levels of a family. It can be concluded the parental attitudes are assumed to be associated with the psychosocial development of children. The aim of this study was to assess parents’ attitudes towards their children with cerebral palsy (CP), and to examine the relationship between parental attitudes, emotional and behavioural problems, and other factors related to a child with CP and their parents. Parents of 70 children with CP (aged 6–13 years) completed questionnaires assessing parental attitudes and the Social and Emotional Behavioural Problematic scale. The results indicated that most parents had moderate attitudes towards their children with CP, although 40.7% of parents held negative attitudes. The results also revealed that there were statistically significant moderate negative correlations between parental attitudes, internalising behavioural problems and child order, and significant moderate positive correlations between parental attitudes, level of education, and type of school. Regression analysis revealed that internalising behaviour problems, aggression, child order, level of disability, parental income, and type of school contributed significantly to the variation in the prediction of parental attitudes towards their children with CP. Based on the findings, appropriate recommendations are suggested.     

Traumatic experience and sleep disturbance in refugee children from the Middle East

BACKGROUND: Sleep disturbance is frequently reported in children after traumatic experiences associated with organised violence. The aim of this study was to identify specific traumatic risk indicators and modifying factors for sleep disturbance among recently arrived refugee children from the Middle East. METHODS: The study group comprises 311, 3-15 year old refugee children from the Middle East. On arrival in Denmark, their parents participated in a structured interview about their childrens' health and history of exile and eventual exposure to war, organised violence and human rights violation. RESULTS: A family history of violence (grandparent's violent death before the birth of the child or parental exposure to torture) as well as a stressful present family situation (father scolds the child more than previously) were the strongest predictors of prevalent sleep disturbance in the children. Arriving in Denmark with both parents rather than one was a modifying factor, so the effect of traumatic experience on sleep patterns later in childhood was mediated through parental presence and behaviour. CONCLUSION: This study indicates that the family environment is of primary importance for childhood sleep disturbance following traumatic experiences connected with war and other organised violence.     

The impact of violence on mothers' and children's needs during and after parental separation

Men's violence against mothers and children as a context of separation significantly increases the immediate and longer-term parenting needs of affected children, according to a South Australian study of single mothers' transition and adaptation to living in a single parent household. Qualitative research interviews with 18 separated mothers who cited violence as the main reason for ending their relationship included mothers' views on how the violence had impacted on their children. Mothers who had fled violence named continuing concerns with their children's behaviour including withdrawal, anxiety and aggression, as well as the children's continuing exposure to violence during contact with their father. These mothers reported that access to professionals to seek help with their concerns about their children's needs was often inadequate.     

The origin of violent behaviour among child labourers in India

Abstract

We explored the causes and circumstances of violent behaviour among a group of child labourers in the Indian unorganized sectors. From 14 categories of occupations, a total of 1,400 child labourers were interviewed in both urban and rural areas. The average family size of these mostly illiterate child labourers is seven, and average family income is 3,200 INR per month. In the short term child labourers become violent, aggressive, and criminal, following a pyramid of violent behaviour, including socio-economic pressure, cultural deviance, and psychological pressure. When considering family history it seems that the problem is part of a vicious cycle of violence, which persists through generations and evolves with financial crisis, early marriage, and violence in the family and workplace. Our study demonstrates that the most vulnerable groups of child labourers belong to the following workplaces: dhabas, food stalls, rail/bus stations, rail-floor cleaning, and rag picking. Giving high priority to capacity building within the community, including support for locally-generated solutions, is warranted.     

Family day care and day care centres: Carer, family and child differences and their implications

The present study investigated child, maternal and caregiver characteristics in two day care settings, the independent contributions of these characteristics to children's adjustment to day care, and the utility of a goodness-of-fit framework as a means of assessing the impact of parent-caregiver differences on children's adjustment. Eight measures were used to assess child behavioural problems, maternal satisfaction with care, child temperament, maternal and caregiver child rearing practices, developmental timetables, day care goals, and demographic background. The study found strong support for the existence of differences between mothers choosing different types of care, between caregivers in these two settings, and between mothers and caregivers; and for the linkage between child, maternal and caregiver characteristics and child adjustment. However, the impact of goodness-of-fit between mothers and caregivers on children's adjustment to day care was not supported.     

Paths to child social adjustment: parenting quality and children's processing of social information

BaCKGROUND: The purpose of this research was to examine the manner in which multiple influences on child social adjustment operated together to predict differential outcomes for young children. Specifically, this study was designed to (i) examine the role of social cognitive and emotional factors in parents' observed and self-reported behaviour towards their children, and (ii) investigate the impact of parenting and children's social information processing (SIP) patterns on children's subsequent social adjustment in the school setting. METHODS: A model of children's peer social adjustment was evaluated using a group of 166 children, over-sampled for history of physical child abuse. Assessment of constructs was multi-method, including parent and child self-reports as well as teacher reports of child adjustment and observations of parent-child and child-peer interactions. RESULTS: Using structural equation modelling, support was found for our theoretical model. Specifically, parents' negative child-related beliefs and clinical elevations in emotional distress were predictors of harsh, insensitive parenting, which in turn predicted children's SIP operations and social maladjustment 6 months later. However, children's SIP did not significantly predict their social adjustment above and beyond the impact of parenting. CONCLUSIONS: Results indicated that the quality of parenting that children received was more central to subsequent adjustment in peer interactions than were children's SIP operations. Furthermore, the quality of parenting children experienced was closely linked to parents' beliefs about their children and parents' mental health status. Directions for future research and potential implications for clinical practice are discussed.     

Brief intervention therapy for behaviourally disturbed pre-school children

Summary A group of children with behavioural difficulties were treated using behavioural techniques and were compared with a group of control children. The treated children had various behavioural difficulties including poor concentration, sleep problems and non-cooperation with parents. They were treated in the home for periods up to 7 weeks, after a 2-week baseline observation period. Of nine families that started the treatment, two did not cooperate and one improved spontaneously. Videotape recordings of the child at play were made lasting 15 minutes and immediately prior to the psychologist's visits. The matched control children were investigated similarly. The videotapes were analysed to assess attention span, mother-child verbal interaction and cooperation. There was consideration improvement in attention span as the treated children's behaviour became similar to the control children in four to five visits. The improvements lasted over the 3- and 6-month follow-up period. It is concluded that brief intervention behavioural treatment has considerable potential and is reasonably economical in terms of staff time.     

Parental use of alcohol and children's behavioural health: a household production analysis

This study uses the 1988 National Health Interview Survey (NHIS) data to examine the effects of both heavy and problem drinking as well as moderate or light parental alcohol use on children's behaviour problems. The analysis is formulated within Becker's household production function framework. The production of child behavioural health is estimated using items from the Behavior Problems Index, a battery of 32 questions about behaviour problems which is derived from the Child Behavior Checklist (CBCL), a widely-used parent report instrument. Measures of parents' alcohol consumption are constructed from the NHIS Alcohol Supplement that was administered to one randomly selected adult in each household in 1988. Ordinary least squares (OLS) and two-stage least squares (TSLS) results are presented. The results provide consistent evidence that parental alcohol use is an input with negative marginal product in the production of child behavioural health, regardless of which parent drinks. The magnitude of the effect is generally larger in the TSLS specification. There is also strong evidence of relationships between some family structure variables and child behavioural health and between parental physical health and child behavioural health.     

Three-year follow-up of a family support service cohort of children with behavioural problems and their parents

Abstract Background The aim of this study was to establish the medium-term (three-year) psychosocial outcome of children with behavioural problems and their parents, who had received an intervention from a family support service. Methods Forty families were traced at the three-year follow-up and agreed to participate. Pre- and post-intervention and follow-up measures were the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the Strengths and Difficulties Questionnaire (SDQ). Results The primary HoNOSCA outcome items (i.e. those initially targeted by the parenting intervention) of aggression/antisocial behaviour and family relationships were not found to have changed significantly from the baseline (but had not sustained the sort-term improvement following the intervention). Deterioration was found in other HoNOSCA items such as overactivity, self-harm, scholastic/language skills, emotional, and poor school attendance. When we compared pre-intervention with follow-up SDQ scores, there was no significant change on any scales, i.e. these had returned to the level reported at the time of the original referral to the family support service. Conclusions Following the intervention from a family support service, children and families reported a significant improvement in most outcome measures, predominantly child behaviour and family relationships. However, these improvements were either not sustained or there were additional difficulties at three-year follow-up. These could be related to various external and developmental factors. This lack of sustainable treatment effects for children with behavioural problems is consistent with previous research findings on parenting programmes.     

How do mothers’ childrearing histories,stress and parenting affect children's behavioural outcomes?

BACKGROUND: Information is needed to understand the role of low to moderate levels of mothers' emotional stress and child characteristics (i.e. prematurity) on parenting behaviours and their impact on children's behaviour that might be deemed 'challenging' but not 'disordered'. METHODS: The direct and indirect relations of maternal childrearing history and emotional stress, and observed parenting practices when children were 3 years of age on 4-year child behavioural outcomes was examined in a sample of low-income families with a term (n=112) or preterm (n=180) child. Parenting practices included displays of warmth and restrictiveness when interacting with their children. Child outcomes at 4 years included observation of social initiations with their mothers and maternal report of social and attentional problems. RESULTS: A Structural Equation Model building approach guided by specific hypotheses indicated that preterm as compared to full-term children had more maternal reported social and attentional problems but did not differ in observed social initiating skills. Greater negative maternal childrearing history indirectly influenced social initiating skills through its direct influence on maternal emotional stress. Greater maternal emotional stress directly influenced mothers' parenting that, in turn, directly influenced social initiating. Prematurity and a more negative childrearing history had a direct negative influence on the maternal report of social and attentional behavioural outcomes. CONCLUSIONS: These findings delineate the effects of prematurity and maternal parenting on the behaviour of 4-year-old-children and extend current knowledge of the influence of parental emotional stress on parenting. Even milder levels can negatively influence parenting, and in turn, contribute to children's less well developed social skills. The issues raised in this study could help with the identification and prioritization of medical and psychological services.     

Psychosocial aspects of the so-called short-bowel syndrome in children

In a retrospective study of 16 patients with (congenital) bowel pathology, aged 2 to 12, attention was paid to the psychosocial aspects of the short bowel syndrome. Parents were interviewed and parents' and teachers' reports of children's behavioural and emotional problems were obtained. Parents as well as children appeared to have reached a reasonable level of adjustment. Parents' emotions concerning the period of hospitalisation still appeared to be strikingly strong. Although most children did not show obvious psychopathology, problems were observed in the areas of behaviour and attention, interfering with optimal school functioning in the case of some children.     

武汉市儿童脑外伤患者家庭负担的前瞻性研究

目的了解武汉市儿童脑外伤后家庭负担变化的基本状况.方法以0～17岁脑外伤患者作为研究对象进行前瞻性研究,分别于儿童住院期间及出院6个月后,利用以上经过检验的家庭负担测量工具,测量儿童家庭所承受的压力和负担及其变化,并利用儿童行为量表（CBCL）对脑外伤后儿童的社会行为能力进行评估.结果113例儿童在脑外伤发生前、住院期间及出院6个月后随访时家庭功能评价问卷（APGAR）平均得分分别为7.96、6.94、7.60分,配对t检验显示,家庭功能在外伤发生后发生障碍,6个月后恢复到外伤发生前的水平,但重度脑外伤对家庭功能的影响在出院6 个月后仍未得到恢复.住院期间疾病家庭负担会谈量表（FBS）得分最高的3个维度分别为家庭经济负担、家庭日常生活、家庭娱乐活动.出院6个月后FBS量表总得分下降,家庭成员心理健康维度得分最高,其次为家庭经济负担维度和家庭关系维度,配对t检验结果表明脑外伤对家庭成员心理健康的影响在儿童出院6个月后尚未得到消除.113例儿童出院6个月后CBCL得分均在正常范围内.结论脑外伤发生后家庭APGAR得分降低,FBS得分提高,表明脑外伤儿童的家庭受到伤害事件的影响,其家庭负担加重,家庭功能发生障碍.随着疾病的康复,除重度脑外伤组以外,脑外伤儿童的家庭功能均可恢复正常.     

Psycho-social outcome of parents and young children after renal transplantation

This cross-sectional study aims to assess whether renal transplantation in children under the age of 6 years has an effect on the child's later behaviour and eating and whether this outcome is related to differences in the levels of stress and coping skills shown by the parents. In this small sample of 14 children aged under 8 years, renal transplantation in the pre-school age range did not have any marked adverse effect on the children's emotional or behavioural state. The children's severe eating problems dramatically improved after transplant. Long-term, early tube-feeding does not impair the development of normal feeding patterns in these children. Parental stress levels were not elevated in the post-transplant period and parents tended to use passive coping strategies to manage the chronic illness in their child.     

Associations between young children’s exposure to household violence and behavioural problems: Evidence from a rural Kenyan sample

ABSTRACT

Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n?=?497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient?=?1.35, SE?=?0.54, p?=?0.01) and harsh psychological child discipline (regression coefficient?=?0.74, SE?=?0.22, p?=?0.001), but not physical discipline (regression coefficient?=?0.42, SE?=?0.24, p?=?0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.     

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.     

Children with liver disease: maternal reports of their adjustment and the influence of disease severity on outcomes

Summary Mothers of 45 children with a liver disease (biliary atresia) completed a questionnaire concerned with their child's health status and psychological adjustment. Emotional and behavioural problems were found to be common; 46% of children under 5 and 43% over 5 years of age scored above the cut-off on standardized measures of adjustment. Maternal mental health difficulties were present in 36% of the sample. The study examined factors that predicted child adjustment, results indicating that maternal perceptions of severity accounted for 40% of the variance in children's psychological adjustment. Neither maternal mental health, nor objective parameters of the child's health status contributed significantly to child adjustment. The findings are discussed in terms of Wallander's model of adaptation to chronic disease and the practical implications for clinical practice are discussed.