BEHAVIOUR PROBLEMS IN SPECIFIC READING RETARDED AND GENERAL READING BACKWARD CHILDREN: A LONGITUDINAL STUDY

A sample of 453 Australian children was followed over the first three years of schooling. Behaviour problems were assessed at the beginning of the first year at school and at the end of the second and third years. At the end of the third year the children were classified as specific reading retarded, general reading backward or normal. At school entry backward readers were found to have behaviour problems, principally relating to attentional deficit. It was concluded that this factor may play a causative role in their reading difficulty. Retarded readers, on the other hand, showed no evidence of behaviour problems.     

Can Cognitive Distortions Differentiate between Internalising and Externalising Problems?

A community sample of 405 adolescents were given the Youth Self-Report Form (YSR) and the Children's Negative Cognitive Errors Questionnaire (CNCEQ). Both regression and group comparison analyses, using the full sample and a subset of extreme scorers, respectively, indicated that internalising problems were specifically associated with the various forms of cognitive distortions assessed, namely, selective abstraction, personalising, overgeneralisation, and catastrophising. Furthermore, they displayed a curvilinear relationship; as the severity of internalising problems increased, the magnitude of cognitive distortions grew positively at a quadratic rate, displaying a U-shaped upward curve. However, in view of the potential measurement bias of CNCEQ toward internalising problems, the conclusion was qualified. Although our results found some specific event/schema-linked cognitive distortions that distinguished internalising from externalising problems, we could not conclude that the latter were free from any other event/schema-linked cognitive distortions that the CNCEQ might have failed to elicit.     

Preschool regulatory problems and attention-deficit/hyperactivity and cognitive deficits at school age in children born at risk: Different phenotypes of dysregulation?

Background

Early regulatory problems (RP), i.e., excessive crying, feeding, and sleeping difficulties, have been reported to be predictors of cognitive and attention-deficit/hyperactivity problems. However, previous studies had limitations such as small sample size or retrospective design.

Aim

To investigate whether persistent RP from infancy until preschool age are precursors of ADHD problems and cognitive deficits at school age.

Study design

A prospective study from birth to 8.5 years of age.

Subjects

1120 infants born at risk.

Measures

RP were assessed at 5 months (i.e., excessive crying, feeding, and sleeping problems), 20, and 56 months (i.e., eating and sleeping problems) via parent interviews and neurological examination. At 8.5 years of age, IQ was assessed by a standard test (K-ABC), and ADHD problems by direct observations in the test situation and by the Mannheimer Parent Interview (MPI, DSM-IV diagnosis of ADHD).

Results

23.8% of the sample born at risk had RP at least at two measurement points until preschool age. Persistent RP predicted lower IQ (β = − .17; 95% CI (− .21; − .10)), behaviour problems (β = − .10; 95% CI (− .15; − .03)), attention (OR 2.43; 95% CI (1.16; 5.09)) and hyperactivity problems (OR 3.10; 95% CI (1.29; 7.48)), and an ADHD diagnosis (OR 3.32; 95% CI (1.23; 8.98)) at school age, even when controlled for psychosocial and neurological confounders.

Conclusions

Early persistent RP increased the odds of ADHD and associated problems at school age, indicating a cascade model of development, i.e., infant behaviour problems provide the starting point of a trajectory of dysregulation through time.     

Nocturnal enuresis: sleep disturbance and behavioural patterns

Sleep pattern and behaviour was studied in 88 children with nocturnal enuresis and compared with 340 non-enuretic children. There were no differences in common psychosomatic complaints. Enuresis was almost three times more common in the families of the enuretic children than in the families of their non-enuretic peers. The enuretics were considered deep sleepers by their parents. A wake-up test showed that they were more difficult to arouse at night compared with controls ( p < 0.001). These results demonstrate that enuresis has a strong genetic link and enuretics are characterized as deep sleepers but do not display different day-time behavioural patterns compared with their non-enuretic peers.     

Prospective effects of violence exposure across multiple contexts on early adolescents’ internalizing and externalizing problems

Background: Violence exposure within each setting of community, school, or home has been linked with internalizing and externalizing problems. Although many children experience violence in multiple contexts, the effects of such cross‐contextual exposure have not been studied. This study addresses this gap by examining independent and interactive effects of witnessing violence and victimization in the community, home, and school on subsequent internalizing and externalizing problems in early adolescence. Methods: A community sample of 603 boys and girls (78% African American, 20% Caucasian) participated in a longitudinal study of youth violence. During two assessments 16 months apart, adolescents reported on witnessing violence and victimization in the community, school, and home, and their internalizing and externalizing problems. Results: Multiple regressions tested the independent and interactive effects of witnessing violence or victimization across contexts on subsequent adjustment, after controlling for initial levels of internalizing and externalizing problems and demographic covariates. Witnessing violence at school predicted anxiety and depression; witnessing at home was related to anxiety and aggression; and witnessing community violence predicted delinquency. Victimization at home was related to subsequent anxiety, depression, and aggression; victimization at school predicted anxiety; and victimization in the community was not independently related to any outcomes. Finally, witnessing violence at home was associated with more anxiety, delinquency, and aggression only if adolescents reported no exposure to community violence. Conclusions: Violence exposure at home and school had the strongest independent effects on internalizing and externalizing outcomes. Witnessing community violence attenuated the effects of witnessing home violence on anxiety and externalizing problems, perhaps due to desensitization or different norms or expectations regarding violence. However, no comparable attenuation effects were observed for victimization across contexts.     

Childhood emotional and behavioural problems: A comparison of children's reports with reports from parents and teachers

Abstract Paediatricians are often asked to assess children with emotional and behavioural problems and are faced with the dilemma that reports about the children's behaviour obtained from the children, and from their parents and teachers, may differ. This study compares the number of childhood emotional and behavioural problems reported by children living in the community, with the number of problems reported by their parents and teachers. When describing both internalizing and externalizing problems, the children consistently reported that they had more problems than were reported by either their parents or teachers. This pattern was particularly evident with reports from older female children who reported many more internalizing problems than were reported by their parents and teachers. Possible reasons for the differences between reports from children and the other informants are discussed.     

Ketoacidosis occurring in newly diagnosed and established diabetic children

A 6-y retrospective case note review was performed to determine the causes of ketoacidosis. 135 patients and 463 diabetic years were involved. Fifty-two ketoacidosis episodes occurred: 19 episodes in new patients and 33 episodes in 19 patients with established diabetes. 27% of newly diagnosed patients presented in ketoacidosis. They were similar in terms of age, sex and proportion living in single parent families to those presenting without ketoacidosis. The 33 ketoacidosis episodes occurring in established patients included 12 episodes in 3 children who were transferred to our care because of uncontrolled diabetes. Insulin omission was the cause of ketoacidosis in 9/19 (47%) patients, and was suspected in a further 5/19 (26%). Family and school problems were common and 14/19 patients came from single parent families. Established patients aged ≥11 y were predominantly female (10F, 2M), whereas patients aged ≥10y were predominantly male (6M, 1F). 7 patients with multiple ketoacidosis episodes were all ≥11 y and 6 were female. Families with ≥2 diabetic children appeared vulnerable, 4 cases coming from 3/7 such families.     

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.     

Practitioner Review: Parenting interventions for child conduct problems: reconceptualising resistance to change

Parenting interventions based on social learning theory have received extensive empirical support in the treatment of child conduct problems; yet, they fail to produce lasting gains in as many as a third of cases. Perspectives on these poor outcomes have been informed by numerous lines of research, and practitioner recommendations for improving such outcomes have often emphasized processes related to clinical engagement. In this Practitioner Review, we examine recent theory and evidence pertaining to these processes, including emerging research into the therapeutic relationship across face-to-face and eHealth treatment modalities, and the clinical engagement of both mothers and fathers. The concept of resistance to change is examined in light of these developments, and it is argued that the process of overcoming such resistance can be characterized as one of reflective practice. A novel process model based on this perspective is presented, comprising practical clinical strategies that are designed to be initiated from the earliest contacts with a family and build on one another across treatment.     

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     

Dysregulated coherence of subjective and cardiac emotional activation in adolescents with internalizing and externalizing problems

Background:  Effective emotion regulation should be reflected in greater coherence between physiological and subjective aspects of emotional responses.
Method:  Youths with normative to clinical levels of internalizing problems (IP) and externalizing problems (EP) watched emotionally evocative film-clips while having heart rate (HR) recorded, and reported subjective feelings.
Results:  Hierarchical linear modeling revealed weaker coherence between HR and negative feelings in youths, especially boys, with more EP. Youths with IP showed coherence between HR and negative feelings that did not match the affect portrayed in the eliciting stimuli, but atypical positive emotions: they felt happier when they had slower HR. Youths without problems predominantly showed normative emotional coherence.
Conclusions:  Youths with EP and IP experience atypical patterns of activation across physiological and experiential emotion systems which could undermine emotion regulation in evocative situations.     

Classes of disruptive behaviour in a sample of young elementary school children

BACKGROUND: The objectives were to (1) classify young children to groups differing in disruptive behaviour, (2) determine whether the patterns of disruptive behaviour in these groups are in accordance with the conceptualisation of disruptive disorders as described in DSM-IV, and (3) optimise the classification of children in groups. METHODS: Disruptive behaviour of 636 seven-year-old elementary schoolchildren was assessed with the CBCL/4-18. Using CBCL items rated as very consistent with DSM-IV categories Conduct Disorder, Oppositional Defiant Disorder and Attention-Deficit/Hyperactivity Disorder, latent class analyses were applied to identify classes of children differing in patterns of disruptive behaviour. RESULTS: Three classes were identified: (1) high levels of oppositional defiant problems (ODD problems) and attention-deficit/hyperactivity problems (ADH problems) and intermediate levels of Conduct problems; (2) intermediate ODD problems and ADH problems and low levels of Conduct problems; (3) low levels on all disruptive behaviours. CONCLUSIONS: No classes were identified in which children had symptoms of only Conduct problems, only ODD problems or only ADH problems. Covariates (socio-economic status, gender, parenting stress) improved the classification of children. The findings are discussed in terms of implications for classification, identification of children at risk, prevention and treatment of disruptive behaviour in young children.     

Psychological problems in children with cerebral palsy: a cross-sectional European study

Objectives: To describe psychological symptoms in 8–12‐year‐old children with cerebral palsy; to investigate predictors of these symptoms and their impact on the child and family. Design: A cross‐sectional multi‐centre survey. Participants: Eight hundred and eighteen children with cerebral palsy, aged 8–12 years, identified from population‐based registers of cerebral palsy in eight European regions and from multiple sources in one further region. Main outcome measures: The Strengths and Difficulties Questionnaire (SDQ)^P4?16 and the Total Difficulties Score (TDS) dichotomised into normal/borderline (TDS ≤ 16) versus abnormal (TDS > 16). Statistical analysis: Multilevel, multivariable logistic regression to relate the presence of psychological symptoms to child and family characteristics. Results: About a quarter of the children had TDS > 16 indicating significant psychological symptoms, most commonly in the domain Peer Problems. Better gross motor function, poorer intellect, more pain, having a disabled or ill sibling and living in a town were independently associated with TDS > 16. The risk of TDS > 16 was odds ratio (OR) = .2 (95% CI: .1 to .3) comparing children with the most and least severe functional limitations; OR = 3.2 (95%CI: 2.1 to 4.8) comparing children with IQ < 70 and others; OR = 2.7 (95% CI: 1.5 to 4.6) comparing children in severe pain and others; OR = 2.7 (95% CI:1.6 to 4.6) comparing children with another disabled sibling or OR = 1.8 (95%CI: 1.2 to 2.8) no siblings and others; OR = 1.8 (95% CI: 1.1 to 2.8) comparing children resident in a town and others. Among parents who reported their child to have psychological problems, 95% said they had lasted over a year, 37% said they distressed their child and 42% said they burdened the family at least ‘quite a lot’. Conclusions: A significant proportion of children with cerebral palsy have psychological symptoms or social impairment sufficiently severe to warrant referral to specialist services. Care must be taken in the assessment and management of children with cerebral palsy to ensure psychological problems are not overlooked and potentially preventable risk factors like pain are treated effectively. The validity of the SDQ for children with severe disability warrants further assessment.