认知疗法在改善学龄期白血病患儿心理行为中的应用

目的探讨认知疗法在改善学龄期白血病患儿心理行为中的应用方法和效果。方法采用儿童行为评定量表（Achenbach,s Child Behavior Checklist,CBCL）对88例白血病患儿心理行为进行调查;并对行为异常的患儿实施认知疗法的干预．比较干预前后患儿CBCL测评结果。结果学龄期白血病男性患儿与女性患儿的心理行为得分超出正常值上限的分别为25．00％和22．92％,显著高于常模的12．93％（P〈0．05）。干预前后男性患儿在活动能力、社交能力、学校能力、社会能力、分裂样、抑郁、社会不良、躯体诉述、攻击性行为因子及行为问题总分比较,差异具有统计学意义（均P〈0．05）。干预前后女性患儿在社会能力、抑郁、社会退缩、躯体诉述、分裂样、多动因子及行为问题总分比较,差异具有统计学意义（均P〈0．05）。结论认知行为疗法可改善学龄期白血病患儿的心理行为。     

The effects of child temperament,maternal characteristics,and family circumstances on the maladjustment of school-age children

Eighty-nine mothers with children between the ages of 8 and 11 years reported perceptions of their child's adjustment and temperament, and described concurrent family circumstances such as socioeconomic status, level of parental distress, major life events experienced, maternal hassles, and their own psychiatric symptoms. A conceptual model hypothesizing the direct and indirect effects of family circumstances, maternal characteristics, and child temperament on the maladjustment of school-age children was tested using causal modeling with residual analysis. Fifty-six percent of child externalizing behavior was directly explained by the negative reactivity and nonpersistence of the child's temperament, and maternal hassles. A total of 33% of the variance of internalizing behavior was explained by the direct effects of negative reactivity of the child's temperament and maternal hassles. For both externalizing and internalizing behavior, a total of 54% of the variance in maternal hassles was explained by three variables: maternal psychiatric symptoms contributed 34%, major life events added 15%, and the intensity of the mother's temperament added an additional 5%. These three variables have a direct effect on maternal hassles and together had an indirect effect of .24 on child externalizing behavior through maternal hassles. Likewise, they have a direct effect on maternal hassles and together had an indirect effect of .31 on child internalizing behavior through maternal hassles.     

Migraine and behavior in children: influence of maternal headache frequency

We took advantage of a large population study in order to measure child behavior, as captured by the Child Behavior Checklist (CBCL) as a function of headache status in the children and their mothers. Of the target sample, consents and analyzable data were obtained from 1,856 families (85.4 %). Headache diagnoses were defined according to the second edition of the International Classification of Headache Disorders, and behavioral and emotional symptoms were assessed by the validated Brazilian version of the CBCL. We calculated the relative risk of abnormalities in the CBCL domains as a function of headache status in the children, after adjusting by a series of main effect models. Children with migraine were more likely to present abnormal scores in several of the CBCL scales, relative to children without migraine, and maternal migraine status contributed little to the model. However, when the mother had daily headaches, both children with and without migraine had similar CBCL scores. In multivariate analyses, migraine status in the children predicted CBCL scores (p < 0.01). Headache status and headache frequency in the mother did not predict CBCL scores in children with migraine but predicted in children without migraine (p < 0.01). The burden of migraine to the family is complex. Children with migraine are more likely to have behavioral and emotional symptoms than children without migraine. Children without migraine may be affected, in turn, by frequent headaches experienced by their mothers.     

Factors associated with academic achievement in children with type 1 diabetes

OBJECTIVE: To examine academic achievement in children with diabetes and to identify predictors of achievement. RESEARCH DESIGN AND METHODS: Participants were 244 children, ages 8-18 years, with type 1 diabetes. Measures included school-administered standardized achievement tests (Iowa Tests of Basic Skills and Iowa Tests of Educational Development [ITBS/ITED]), grade point averages (GPAs), school absences, behavioral assessment, age at disease onset, hospitalizations, and HbA(1c). Statistical differences between subgroups of children were evaluated using t test and ANOVA, statistically controlling for socioeconomic status. Regression analyses were carried out to examine predictors of academic performance. RESULTS: Reading scores and GPA were lower for children with poor metabolic control than for children with average control. Children with hospitalizations for hyperglycemia had lower overall achievement scores than children with better metabolic control and fewer hospitalizations for hyperglycemia. The small group of children with tight metabolic control and hypoglycemic hospitalizations scored particularly low on the ITBS/ITED. Other variables had less clear relationships with academic achievement. Neither early onset of diabetes nor frequent school absence was associated with lower scores on the ITBS/ITED. Sex comparisons found that boys performed better than girls only in math. Socioeconomic status and parent ratings of behavior problems were significantly correlated with academic achievement, but medical variables added only slightly to predictive precision. CONCLUSIONS: For most children with diabetes, medical variables are not as strongly associated with academic achievement as are factors such as socioeconomic status and behavioral factors. Poor metabolic control and serious hypoglycemia, however, are a potential concern for a subset of these children.     

The Mental Health of Homeless School-Age Children

PROBLEM: The mental health of homeless school-age children. METHODS: A convenience sample of 46 homeless children between the ages of 8 and 12 years completed the Children's Depression Inventory (CDI) and each child's mother completed the Child Behavior Checklist (CBCL). FINDINGS: Fifty-seven percent of the children had depressive symptoms and 26% needed additional evaluation for mental health problems. Overall, the CDI and CBCL scores indicated that gender or ethnicity are not related to the children's mental health. CONCLUSIONS: The mental health of homeless schoolage children should be assessed, as they may be at risk for mental health problems.     

Factors related to emotional responses in school-aged children who have asthma

A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who have asthma? (b) What are the potential gaps in the literature regarding the emotional responses of school-age children (ages 6-12) who have asthma? (c) Are children with a lower socioeconomic status (SES) and those who are minorities represented in the literature proportionate to their prevalence? Two main focus areas regarding emotional responses were identified: (a) factors related to children who have asthma and (b) factors related to caregivers of children who have asthma. Internalizing disorders were reported consistently for children and caregivers of children who have asthma. Negative consequences of asthma for children included panic and asthma attacks, missed school days, and behavioral problems. Issues for caregivers included higher levels of anxiety and depressive symptoms, asthma management deficits, and lower caregiver warmth and involvement. Gaps in the literature included separated studies for children ages 6-12, a lack of a standardized method to define SES, studies that were of a more experimental nature, and a disparate number of studies of minority children and caregivers relative to their asthma prevalence.     

Factors Related to Emotional Responses in School-aged Children Who Have Asthma

A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who have asthma? (b) What are the potential gaps in the literature regarding the emotional responses of school-age children (ages 6–12) who have asthma? (c) Are children with a lower socioeconomic status (SES) and those who are minorities represented in the literature proportionate to their prevalence? Two main focus areas regarding emotional responses were identified: (a) factors related to children who have asthma and (b) factors related to caregivers of children who have asthma. Internalizing disorders were reported consistently for children and caregivers of children who have asthma. Negative consequences of asthma for children included panic and asthma attacks, missed school days, and behavioral problems. Issues for caregivers included higher levels of anxiety and depressive symptoms, asthma management deficits, and lower caregiver warmth and involvement. Gaps in the literature included separated studies for children ages 6–12, a lack of a standardized method to define SES, studies that were of a more experimental nature, and a disparate number of studies of minority children and caregivers relative to their asthma prevalence.     

Maternal factors associated with child behavior.

BACKGROUND: Knowledge of the relative contributions of risk factors in predicting young children's behavior problems may provide insights for the development of preventive interventions. OBJECTIVE: The purpose of this cross-sectional study was to identify maternal predictors of children's internalizing and externalizing behaviors in a volunteer sample of 205 low-income, single mothers with children between 2 and 6 years of age. METHOD: Data were collected on chronic stressors, self-esteem, negative thinking, depressive symptoms, and child behavior during in-home interviews with the mothers. RESULTS: Mothers' reports of internalizing and externalizing behaviors did not differ by sex or race of the child. Chronic stressors and depressive symptoms, in addition to control variables, explained 27% of the variability in internalizing behavior while these two variables accounted for 21% of the variability in externalizing behavior. For both internalizing and externalizing behavior, chronic stressors exerted the largest total effects. The effects of self-esteem and negative thinking were indirect, with the latter playing a stronger role. The indirect effect of negative thinking on child behavior was exerted through depressive symptoms, while self-esteem was linked with child behavior through both negative thinking and depressive symptoms. CONCLUSIONS: Decreasing mothers' negative thinking, a variable amenable to intervention, may not only decrease a mother's depressive symptoms but also improve her perception of the child's behavior. CLINICAL RELEVANCE: Decreasing mothers' negative thinking may provide a way to reduce their depressive symptoms and result in fewer behavior problems among their young children. Nurses working in primary care and community-based settings are in key positions to address this problem and improve the mental health of low-income mothers and positively affect the behavior of their children.     

The relationship of temperament to pre- and posthospitalization behavioral responses of school-age children

The relationship of temperament to pre- and posthospital behavioral responses of school-age children was examined in this study. Seventy-five children, aged 8 to 12, who experienced unplanned hospitalizations were studied. Data were collected from the children's mothers who served as the primary informants. The mothers completed questionnaires describing their children's temperament and behavior pre- and posthospitalization. Temperament accounted for more than 50% of the variance in the children's behavior prior to hospitalization and at 1 week and at 1 month following discharge. The subjects' usual prehospitalized temperament was significantly more withdrawn than the established norms of the temperament instrument. However, the subjects did not differ from the norms at either 1 week or 1 month following discharge.     

A Review of Intervention Programs to Prevent and Treat Behavioral Problems in Young Children with Developmental Disabilities

Children with developmental disabilities are at higher risk for internalizing and externalizing behavioral problems than children in the general population. Effective prevention and treatment programs are necessary to reduce the burden of behavioral problems in this population. The current review identified 17 controlled trials of nine intervention programs for young children with developmental disabilities, with parent training the most common type of intervention in this population. Nearly all studies demonstrated medium to large intervention effects on child behavior post-intervention. Preliminary evidence suggests interventions developed for the general population can be effective for children with developmental disabilities and their families. A greater emphasis on the prevention of behavior problems in young children with developmental disabilities prior to the onset of significant symptoms or clinical disorders is needed. Multi-component interventions may be more efficacious for child behavior problems and yield greater benefits for parent and family adjustment. Recommendations for future research directions are provided.     

Competence of and emotional/behavioral problems in pediatric oncology patients in Taiwan

The objective of this study was to examine the factor structure of Achenbach's Child Behavior Checklist, using confirmatory factor analysis, in a group of pediatric oncology patients in Taiwan and to compare the competence and behavioral/emotional problems scores of these children with normative scores to assess competence and emotional/behavioral problems of Taiwanese children with cancer. Subjects included parents (124 mothers and 22 fathers) of 146 pediatric oncology patients who completed the measures. Factor loadings of the overall fit indices for the study subjects yielded or approached satisfactory results for all syndromes, except for aggressive behavior. The indices for both internalizing and externalizing syndromes also showed good model fit. Taiwanese children with cancer had significantly lower competence scores on the Child Behavior Checklist/4-18 than did Achenbach's sample, except Taiwanese girls with cancer, who had higher activity competence scores, but these scores were not statistically significant. Taiwanese boys with cancer had significantly higher scores on all of the emotional/behavioral problems, but had lower delinquent behavior, aggressive behavior, and externalizing syndrome scores. In contrast, girls with cancer had significantly higher scores on somatic complaints and internalizing syndrome, but significantly lower aggressive behavior and externalizing syndrome scores. Taiwanese adolescents with cancer had significantly lower competence scores compared with normative scores, with the exception being that the adolescents in the current study had significantly higher school competence scores. These adolescents also had significantly fewer attention problems but tended to have more somatic complaints. These findings clearly indicate that healthcare for children with cancer should include psychological services to prevent long-term emotional/behavioral problems.     

伴有对立违抗障碍注意缺陷多动障碍患儿智力和行为特征及与血清 5- 羟色胺水平的关系

背景对立违抗障碍( ODD)以对抗等行为为特征,常与注意缺陷多动障碍( ADHD)并存.有研究报道 ADHD合并 ODD比单纯 ADHD有更广泛的损害;有研究认为血清低 5 羟色胺水平可能与 ADHD的攻击性行为有关,国内报道较少. 目的探讨 ADHD合并 ODD的临床特征及与 5 羟色胺的关系. 设计 2002- 06/2003- 05以伴有和不伴有 ODD的 ADHD患儿为研究对象的对照性研究. 单位湘雅二医院精神卫生研究所. 对象研究对象来源于 2002- 06/2003- 05在中南大学儿童精神卫生专科门诊就诊的 7 14岁 ADHD患儿共 61例(男 53例,女 8例),按 DSM Ⅳ关于对立违抗障碍的症状学标准,将 ADHD儿童分为不伴 ODD组( n=33, ADHD组)和伴 ODD组( n=28, ADHD+ ODD组). 方法由患儿父母( n=61)填写 Achenbach儿童行为量表( CBCL),由班主任 (n=31)填写教师报告表( TRF),检测当日早餐被试者进不含巧克力、牛奶的正常饮食,空腹采静脉血 2 mL,用外标法定量测定 5 HT浓度,采用 LD 10AD高效液相色谱仪测定. 主要观察指标伴有和不伴有 ADHD儿童 CBCL, TRF、中国韦氏儿童智力量表 (C WISC),以及血清 5 羟色胺水平差异. 结果经父母和教师评定, ADHD+ ODD组在 CBCL和 TRF攻击性行为分量表、外向性行为问题及行为问题总分显著高于单纯 ADHD组,差异有显著性意义( t=2.28～ 3.76, P< 0.05～ 0.01); ADHD+ ODD组 CBCL的焦虑 /抑郁及内向性行为问题也明显高于 ADHD组,差异有显著性意义( t=2.27～ 2.35, P< 0.05). ADHD+ ODD组的血清 5 羟色胺水平 [(327.01± 164.84)μ g/L]低于 ADHD组 [(451.11± 250.89)μ g/L], 差异有显著性意义( t=2.32, P< 0.05). 结论 ADHD+ ODD儿童在内、外向性问题和适应能力、注意力诸方面均有损害;攻击性行为和 5 羟色胺降低可能是 ADHD+ ODD儿童冲动行为的生物学标记.     

Predicting trajectories of behavioral adjustment in children diagnosed with acute lymphoblastic leukemia

Purpose

Previous research showed that children with cancer are at risk for developing behavioral adjustment problems after successful treatment; however, the course of adjustment remains unclear. This study focuses on adjustment trajectories of children during treatment for acute lymphoblastic leukemia (ALL) and aims to distinguish subgroups of patients showing different trajectories during active treatment, and to identify sociodemographic, medical, and psychosocial predictors of the distinct adjustment trajectories.

Methods

In a multicenter longitudinal study, 108 parents of a child (response rate 80 %) diagnosed with ALL were assessed during induction treatment (T0), after induction/consolidation treatment (T1), and after end of treatment (T2). Trajectories of child behavioral adjustment (Child Behavior Checklist; CBCL) were tested with latent class growth modeling (LCGM) analyses.

Results

For internalizing behavior, a three-trajectory model was found: a group that experienced no problems (60 %), a group that experienced only initial problems (30 %), and a group that experienced chronic problems (10 %). For externalizing behavior, a three-trajectory model was also found: a group that experienced no problems (83 %), a group that experienced chronic problems (12 %), and a group that experienced increasing problems (5 %). Only parenting stress and baseline QoL (cancer related) were found to contribute uniquely to adjustment trajectories.

Conclusions

The majority of the children (77 %) showed no or transient behavioral problems during the entire treatment as reported by parents. A substantial group (23 %) shows maladaptive trajectories of internalizing behavioral problems and/or externalizing behavioral problems. Screening for risk factors for developing problems might be helpful in early identification of these children.

     

缺铁性贫血对学龄前儿童智能和行为能力的影响

目的调查学龄前儿童缺铁性贫血对智能和行为能力的影响。方法选择2001年2月至2005年3月门诊和住院的缺铁性贫血患儿（4—6岁）51例,治疗前接受Achenbach儿童行为量表（child behavior check-list,CBCL）测试;对照组来源于同期来体检的健康儿童（4—6岁）68例。结果两组儿童CBCL社会能力测评中,缺铁性贫血组男、女童的活动能力、社交能力和学习情况等因子得分明显低于对照组（P〈0．05或0．01）。两组儿童CBCL行为能力测评中,缺铁性贫血组男童的分裂样、抑郁、交往不良、强迫性社交退缩、多动、攻击性、违纪等因子得分以及CBCL总分均明显高于正常男童（P〈0．05或0．01）;缺铁性贫血组女童的抑郁、社交退缩、躯体诉述、分裂强迫、多动、性问题、违纪、攻击性和残忍等因子得分及CBCL总分均明显高于正常女童（P〈0．05或0．01）。诘论缺铁性贫血的学龄前患儿均存在明显的活动和行为能力障碍。     

低铅暴露对学龄前儿童神经行为的影响

背景:环境铅污染日趋严重,铅致中枢神经系统发育的毒性较为突出。目的:观察低血铅水平对学龄前儿童神经行为的影响,为预防儿童行为问题提供依据。设计:抽样调查。单位:中山大学公共卫生学院儿少卫生教研室。对象:于2004-09/10随机整群抽取珠海市某居民区幼儿园211名4～6岁儿童为研究对象,其中男109名,女102名。方法:采指端末梢血20μL,原子吸收石墨炉法测定血铅,以血铅水平100μg/L为界,分为高血铅组(>100μg/L),低血铅组(<100μg/L),又以不同血铅水平再分为<50μg/L组、50μg/L～组、100μg/L～组、150～μg/L组、250μg/L～组。采用Achenbach儿童行为量表和自拟调查表(包括可能影响儿童神经行为的因素,如年龄、性别、抚养方式和家庭文化背景等)进行问卷调查,在专业人员指导下,由家长填写。结果与血铅值进行简单相关和多元逐步回归分析。主要观察指标:①血铅水平和Achenbach儿童行为量表各因子分。②血铅值与行为因子分相关分析。结果:发放问卷211份,回收211份,有效211份,有效率100%。①高血铅组外向行为得分及行为异常率(13.28±6.26,18.26%)显著高于低血铅组(9.98±5.46,7.29%)(t=4.0677,χ2=5.470,P<0.05),Achenbach儿童行为量表内向得分及总分两组差异无显著性意义。②不同组别血铅水平行为异常率差异有显著性(χ2=13.695,P<0.01),进一步两两比较,血铅≥150μg/L行为异常率显著高于前3组(χ2分别为4.727,6.261,5.168;4.503,5.911,4.928,P均<0.05),表明血铅≥150μg/L时,儿童行为异常率显著增多。③血铅对数值与多动、攻击、违纪因子分显著正相关(r=0.3164,0.2828,0.1886,P<0.05)。与肥胖、分裂、残忍、性问卷无相关性(r=0.1024,0.0942,0.1183,0.0926,P>0.05)。④经逐步回归分析,多动、攻击及违纪因子分列入回归方程,这表明在控制家庭,社会等混杂因素后,铅对儿童外向行为的影响依然存在,有统计学意义。结论:低水平铅暴露对幼儿外向行为具有负性影响。     

Predicting Residential Treatment Outcomes for Emotionally and Behaviorally Disordered Youth: The Role of Pretreatment Factors

This study examined outcomes with 170 children and youth admitted to residential treatment with complex mental health problems. Overall, outcomes at 2 years post-treatment was predicted by children and youth's behavioral pretreatment status reflected in lower internalizing and externalizing behavior at admission. These findings recognize a cluster of variables upon admission that are differentially predictive of specific outcomes. Higher school participation/achievement and an absence of witnessing interparental abuse predicted educational status. Family status was predicted at admission by higher family functioning, being younger in the family, and children and youth who had poor community behavior. The results are discussed as they relate to pretreatment screening and the need to evaluate service outcomes.     

不同临床状况抽动障碍儿童的行为特征分析

目的 评估抽动障碍儿童的行为,分析不同临床状况抽动障碍儿童的行为特征.方法 选用儿童行为调查表(CBCL)对63例抽动障碍儿童进行评分,通过方差分析、t检验分析抽动障碍儿童不同临床类型、不同抽动严重程度、是否共患注意缺陷多动障碍(ADHD)的CBCL总分及各因子得分.结果 3种不同临床类型间CBCL总分及各因子得分差异未见统计学意义(P＞0.05),中重度抽动障碍组躯体主诉(4.15±2.34)分高于轻度抽动障碍组(2.68±2.22)分(t=-2.540,P=0.014),共患ADHD组在注意问题(9.94±3.57)分、违纪行为(3.94±3.06)分、攻击行为(15.39±5.12)分、外向性行为( 13.98±7.34)分、CBCL总分(47.89±17.51)分高于单纯抽动障碍组[分别为(7.31±3.34)、(2.44±2.22)、(7.24±4.93)、(9.78±6.55)、(37.07±17.98)分,t值分别为-2.774、-2.166、-1.930、-1.956、-2.174,P值分别为0.007、0.034、0.048、0.041、0.034].结论 不同临床状况抽动障碍儿童行为问题的发生和行为特征各不相同,其中是否共患ADHD对行为问题影响最明显.     

Social information processing skills in adolescents with traumatic brain injury: Relationship with social competence and behavior problems

Objective: To examine social information processing (SIP) skills, behavior problems, and social competence following adolescent TBI and to determine whether SIP skills were predictive of behavior problems and social competence. Design: Cross-sectional analyses of adolescents with TBI recruited and enrolled in a behavioral treatment study currently in progress.Setting: Two tertiary care children's hospitals with Level 1 trauma centers. Participants: Adolescents aged 11 to 18 years with severe TBI (n=19) and moderate TBI (n=24) who were injured up to 24 months prior to recruitment. Assessment of risk factors: TBI severity, race, maternal education, and age at testing. Main outcome measurements: a measure of SIP skills, Child Behavior Checklist (CBCL), Youth Self Report (YSR), and Home and Community Social Behavior Scale (HCSBS). Results: The severe TBI group did not obtain significantly lower scores on the SIP measures than the moderate TBI group. In comparison to adolescents with moderate TBI, those with severe TBI had significantly more parent-reported externalizing behaviors and self-reported weaknesses in social competence. SIP skills were strong predictors of problems and social competence in adolescents with TBI. More specifically, an aggressive SIP style predicted externalizing problems and a passive SIP style predicted internalizing problems. Both passive and aggressive SIP skills were related to social competence and social problems. Conclusions: Adolescents with TBI are at risk for deficits in social and behavioral outcomes. SIP skills are strongly related to behavior problems and social competence in adolescents with TBI. SIP skills, social competence, and behavior problems are important targets for intervention that may be amenable to change and lead to improved functional outcomes following TBI.     

Parent report of mealtime behavior and parenting stress in young children with type 1 diabetes and in healthy control subjects

OBJECTIVE: This study assessed parent report of mealtime behavior and parenting stress in preschoolers with type 1 diabetes. It was hypothesized that children with type 1 diabetes would be seen as exhibiting more mealtime behavior problems and that their parents would evidence greater parenting stress when compared with healthy subjects. It was also hypothesized that report of mealtime behavior problems would be positively correlated with parenting stress. RESEARCH DESIGN AND METHODS: A total of 40 children (aged 1-6 years) with type 1 diabetes were recruited from a pediatric hospital. Another 40 children matched for age, sex, marital status, and socioeconomic status were used as control subjects. Reliable and valid parent report measures, such as the Behavioral Pediatrics Feeding Assessment Scale and the Parenting Stress Index, were used for data collection. RESULTS: Parents of children with type 1 diabetes reported more behavioral feeding problems than parents of healthy control subjects. Additionally, parents of children with type 1 diabetes reported higher frequencies of parenting behaviors associated with poor nutritional intake and a greater number of parenting problems concerning mealtimes when compared with parents of healthy control subjects. Parents of children with type 1 diabetes also reported higher stress levels than parents of control subjects. A moderate relationship between mealtime behavior problems and general parenting stress was observed for families coping with type 1 diabetes. CONCLUSIONS: Mealtime problems reported in preschool children with type 1 diabetes are appropriate targets for behavioral intervention. Behavioral observation techniques and training in child behavior management skills should be used in future research aimed at assessing and treating barriers to effective nutrition management in young children with type 1 diabetes.     

Early predictors of post-hospital adjustment problems in critically ill young children

Toddlers and preschool children have been identified as being at risk for post-hospital behavioral sequelae, especially when confronted with an unanticipated intensive care unit (ICU) hospitalization. The purpose of this predictive secondary analysis was to determine demographic and clinical variables that could be assessed early during hospitalization to predict internalizing and externalizing behaviors and negative behavioral change of 2- to 7-year-old children at 3 and 6 months following an unanticipated critical care hospitalization (n = 163 mother-child dyads). The children's behavioral predilections prior to hospitalization (i.e., internalizing or externalizing behaviors) and sex, as well as elevated maternal state anxiety, marital status, and level of emotional care giving by mothers, significantly predicted child internalizing and externalizing behavior and post-hospitalization behavior changes. Results suggest several risk factors that predispose children to poor outcomes following an unanticipated hospitalization that could be targeted for intervention to improve children's emotional and behavioral health.