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Maternal depressive symptoms and child behavior problems in a nationally representative normal birthweight sample.

OBJECTIVE: To evaluate the association between maternal depressive symptoms and child behavior problems in a nationally representative sample of U.S. mothers of normal birthweight babies. METHODS: We analyzed data from the 1988 National Maternal and Infant Health Survey (NMIHS) and a 1991 follow-up survey. Depressive symptoms were measured at both surveys using the CES-D, and child behavior problems were assessed by maternal self-report at follow-up. RESULTS: Approximately 28% of the 5303 mothers reported depressive symptoms at a mean of 17 months after delivery, as did 20% at 36 months. In multivariate analyses, women with depressive symptoms at either or both surveys were significantly more likely than women without depressive symptoms to report that their children had frequent temper tantrums or difficulty getting along with other children, and were difficult to manage, unhappy, or fearful. Compared to women without depressive symptoms, the risks of reporting three out of the five child behavior problems for women with depressive symptoms were OR = 1.6 (CI = 1.1-2.1), 1988 only; OR = 2.3 (CI = 1.6-3.3), 1991 only; and OR = 3.6 (2.6-5.0), both 1988 and 1991. CONCLUSIONS: Study findings indicate that a substantial proportion of mothers of young children in the United States experience depressive symptoms and that their children are at significantly increased risk of maternally reported behavior problems. Our results suggest that efforts to identify and treat depression in new mothers should be increased and that mothers whose children are found to have behavior problems should be assessed for depression.

Adolescent↗

Child behavior problems increased by maternal smoking during pregnancy.

We investigated the effects of maternal smoking during pregnancy on behavioral problems (i.e., not mediated by low birth weight) in 3-y-old offspring. We assessed behavioral problems in 1377 2- to 3-y-old twin pairs (registered in the Netherlands Twin Register) with the Child Behavior Checklist for ages 2-3 y (CBCL/2-3) from Achenbach, Edelbrock, and Howell. Two to 3 y earlier (i.e., soon after the birth of the twins) we collected information about the smoking habits (i.e., "never," "sometimes," and "regularly") of the mother during pregnancy. We analyzed the effect of maternal smoking on the CBCL total score and on several subscale scores for first- and second-born twins separately, and we adjusted for the possible confounding effects of birth weight, socioeconomic status, maternal age, and type of feeding (i.e., breast or bottle fed). There was a significant effect of maternal smoking on so-called "externalizing" behavioral problems (e.g., oppositional, aggressive, overactive), but not on "internalizing" behavioral problems (e.g., withdrawn, depressed, anxious), in both first- and second-born twins. The enhanced "externalizing" problems were attributed predominantly to increased aggression. Although boys have higher externalizing and aggression scores than girls, the effect of maternal smoking was the same for boys and girls.

Child Behavior Disorders↗

Behavior problems and social competence in girls with true precocious puberty.

We report a controlled standardized behavioral assessment of 33 girls with true precocious puberty using the Child Behavior Checklist. Although a majority of the girls were reported not to have behavior problems, many were reported to have a dysphoric adjustment to their condition. Twenty-seven percent of the girls with true precocious puberty scored greater than 2 SD above the mean on the Total Behavior Problem scale 10 times the expected prevalence rate. They also scored significantly higher (P less than 0.01) than matched controls on both the internalizing or "overcontrolled symptom" and externalizing or "undercontrolled symptom" scales. Forty-eight percent scored greater than 2 SD above the mean on the Social Withdrawal scale. The high prevalence of reported problem behaviors in this sample may be related directly or indirectly to the precocious maturation mediated by biologic, psychologic, social, and environmental variables. Although elevated levels of sex steroids may directly contribute to increased aggressive and hyperactive behaviors, they may also be modified by social and environmental factors.

Adaptation, Psychological↗

Behavioral problems and severity of tics.

This study examined the incidence of behavioral symptoms in youngsters with tic disorders. A total of 186 patients were studied using the Child Behavior Checklist and a Motor/Vocal Tic Severity Scale. The relationship between tic severity and the frequency of behavioral symptoms was found to be not simply linear, but influenced by the presence of patients without significant behavioral problems in spite of severe tics (resilient patients) and patients with very negative adjustment although their tic disorder was mild (vulnerable patients). Behavioral problems were not related to age. Patients who were receiving medication showed behavioral problems of different severity from those who were not receiving such agents; this result emphasizes the need for future studies to consider carefully the effects of medication.

Adolescent↗

Measuring problem behaviors in dementia: developing a methodological agenda.

As many as 90% of persons with dementing illness demonstrate problem behaviors that range from repetitive verbalizations, agitation, and wandering to verbal and physical aggression toward self and others. Reliable and accurate measurement of these behaviors is crucial for tracking illness progression; for monitoring the effects of pharmacologic and behavioral interventions; and for continued investigation into the correlates of caregiver stress, burden, and coping. However, there is no single, universally accepted measure or methodology for operationalizing problem behaviors, and variations in definition and measurement across studies complicate drawing meaningful conclusions about these behaviors. This article is an overview of five factors that have complicated accurate and dependable measurement of problem behaviors in dementia: the shifting domain of problem behaviors, slippage across research constructs, unexplored rater bias, scoring bias, and the absence of benchmarking studies. A methodological agenda is discussed for future investigations in this rapidly growing area of gerontological research.

Behavior↗

Resilience and vulnerability among preschool children: family functioning, temperament, and behavior problems.

OBJECTIVE: To examine the effects of child temperament and stressful family functioning on child behavior problems among preschool children. METHOD: One hundred forty-five preschool children, aged 2 to 5 years, were evaluated by teachers, mothers, and independent observers. Teachers reported on child temperament; from these ratings, two dimensions of temperament were derived: difficult/easy and approachability. Mothers reported on two dimensions of family functioning: conflict and expressiveness. Both teachers and independent observers rated child behavior problems. RESULTS: Children with more difficult temperaments who were in high-conflict families had the most internalizing and externalizing behavior problems, while children with easy temperaments had fewer such problems, regardless of levels of family conflict. Difficult children whose families were highly expressive engaged in the most observed aggression. CONCLUSIONS: Results suggest that temperament is involved in both protective and vulnerability processes. A difficult temperament operates as a vulnerability factor for internalizing and externalizing behavior problems and observed aggression, while an easy temperament functions as a protective mechanism for these outcomes.

Child Behavior Disorders↗

Timing of paternal substance use disorder cessation and effects on problem behaviors in sons.

The developmental timing of paternal substance use disorder (SUD) offset on internalizing and externalizing problem behaviors was examined in prepubertal sons. Analyses revealed a significant main effect of the developmental timing of SUD offset on both internalizing and externalizing problems. No differences were found between sons of control-subject fathers and SUD+ fathers whose offsets occurred before the son's sixth birthday. However, when paternal SUD extended beyond the boys' sixth year, significant increases in internalizing and externalizing problem behaviors were found. The results suggest the importance of early parental SUD intervention in prevention of the intergenerational transmission of behavioral problems.

Age Factors↗

Development of adolescent problem behavior.

The developmental model of adolescent antisocial behavior advanced by Patterson and colleagues (e.g., Patterson, Reid, & Dishion, 1992) appears to generalize the development of a diverse set of problem behaviors. Structural equation modeling methods were applied to 18-month longitudinal data from 523 adolescents. The problem behavior construct included substance use, antisocial behavior, academic failure, and risky sexual behavior. Families with high levels of conflict were less likely to have high levels of parent-child involvement. Such family conditions resulted in less adequate parental monitoring of adolescent behavior, making associations with deviant peers more likely. Poor parental monitoring and associations with deviant peers were strong predictors of engagement in problem behavior. These constructs accounted for 46% of the variance in problem behavior. Although association with deviant peers was the most proximal social influence on problem behavior, parental monitoring and family factors (conflict and involvement) were key parenting practices that influenced this developmental process.

Achievement↗

The difficult temperament in adolescence: associations with substance use, family support, and problem behaviors.

This study investigated interrelations between the number of difficult temperament factors (e.g., arrhythmicity, inflexibility, high distractibility) and substance use, perceived family support, and problem behaviors for a sample of 297 adolescents (M age = 15.7 years). The number of adolescent difficult temperament factors was associated significantly with more childhood behavior problems (e.g., hyperactivity, conduct disordered symptoms), which suggests some continuity of disordered behavior from childhood to adolescence. Number of adolescent difficult temperament factors also was associated with a higher percentage of substance users (for cigarettes, alcohol, marijuana, hard drugs), lower perceived family support, higher levels of depressive symptoms, and more delinquent activity. Number of difficult temperament factors was not associated significantly with gender or age of respondents.

Adolescent↗

Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents.

Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. Despite an increasing prevalence of chronic childhood conditions and heightened concerns for the quality of life of the chronically ill, population-based studies of behavior problems among children with chronic physical conditions are rare. Findings on the epidemiology of behavior problems in a nationally representative sample of 11,699 children and adolescents aged 4 to 17 years in the United States are reported. Data included a 32-item parent-reported behavior problem index, measures of chronic childhood conditions, measures of school placement and performance, and sociodemographic variables. Analyses confirmed that chronic physical conditions were a significant risk factor for behavior problems, independent of sociodemographic variables. Among children these differences were observed across all subscales; among adolescents the largest differences were found for the Depression/Anxiety and Peer Conflict/Social Withdrawal subscales. Rates of extreme behavior problem scores (those in the top 10th percentile) were 1.55 times higher among children with a chronic health condition compared with children without a chronic condition (95% confidence interval 1.29 to 1.86). These independent odds were lowered to 1.44 when covariates for confounding were introduced via a multivariate logistic regression. Other independent risks included the absence of either biologic parent (odds ratio 2.05), male gender (1.53), low vs high family income (1.30), low vs high maternal education (1.51), and young vs old maternal age at childbirth (2.57). Chronic health conditions were also a major risk factor for placement in special education classes and having to repeat grades. Despite evidence for effective interventions, health services for children with chronic conditions--particularly mental health services--remain fragmented, signaling the need for increased attention to behavioral problems and their treatment among all health professionals caring for children.

Adolescent↗

The Dual Role of Executive Functioning in the Association Between Family Socioeconomic Status and Children's Problem Behaviors.

Although prior research suggests that executive functioning may either mediate or moderate the association between family socioeconomic status (SES) and children's problem behaviors, examining these roles separately provides an incomplete account: mediation models may understate individual differences that are not attributable to the environment, whereas moderation models may understate the role of the environment in shaping personal characteristics. To integrate these perspectives, the present longitudinal study examined whether executive functioning simultaneously mediates and moderates the association between family SES and children's internalizing and externalizing problems. A total of 308 children in the early years of elementary school (MageT1 = 7.34 years; 138 girls) were assessed and followed up 39 months later. After controlling for children's gender, age, and grade, lower family SES at T1 significantly predicted higher levels of both internalizing and externalizing problems at T2. Executive functioning at T1 partially mediated these associations, indicating that differences in children's executive functioning partly accounted for socioeconomic disparities in problem behaviors. Executive functioning also moderated both associations: SES was negatively associated with problem behaviors among children with lower executive functioning but not among those with higher executive functioning. These findings highlight the dual role of executive functioning in the longitudinal association between SES and children's problem behaviors and suggest that executive functioning may be a promising target for efforts to reduce mental health disparities associated with socioeconomic disadvantage.

Humans↗

Fighting as a marker for multiple problem behaviors in adolescents.

PURPOSE: Behaviors that put adolescents at risk frequently occur together. To help identify high-risk adolescents, we analyzed a national, self-reported behavior survey of high school students to assess the suitability of fighting as a marker for students with multiple problem behaviors. METHODS: A cross-sectional cluster survey of 11,631 U.S. high school students in 1990 was used to compare the prevalence of recent problem behaviors among all students and those who fight. RESULTS: One (8%) of every 12 students was in a fight during the 30 days before the survey. Reported problem behaviors were prevalent among fighters: during the previous 12 months, 24% attempted suicide; during the previous 30 days, 26% carried a firearm, 13% used cocaine, and 39% drove a motor vehicle while intoxicated; during the previous 3 months 41% had two or more sex partners; and 45% had sexual intercourse and did not use a condom the last time they had sex. Of all students, fighters accounted for 22% of those who reported attempting suicide, 49% carrying a firearm, 46% using cocaine, 18% driving while intoxicated, 25% having sex with multiple partners, and 11% not using condoms. Three or more of these six problem behaviors were reported by 26% of the fighters. The problem behaviors were all positively correlated, and the first principal component accounted for 35% of the total variation among the individual variables.

Adolescent↗

Manipulating antecedent conditions to alter the stimulus control of problem behavior.

In a three-phase study, antecedent conditions involving instructor's task demands and social comments were evaluated for 3 students with severe disabilities who emitted problem behavior. The results of a descriptive analysis (Phase 1) demonstrated that task demands served as antecedents for problem behavior, and social comments were generally associated with increased levels of positive social affect. In a subsequent experimental analysis (Phase 2), an instructor emitted high rates of social comments and gradually faded in task demands across sessions. The results of Phase 2 showed initial reductions in problem behavior to near-zero levels from the onset of intervention, with the successful reintroduction of task demands for all students. Phase 3 replicated the procedures of Phase 1. The results demonstrated that for 2 students, task demands no longer served as antecedents to problem behavior. The outcomes from two social validity assessments indicated that substantial improvements were perceived in student behavior and that the independent variable was a socially acceptable means of reducing problem behavior.

Adult↗

Gender differences in the frequency and treatment of behavior problems in Parkinson's disease. SAGE Study Group. Systematic Assessment and Geriatric drug use via Epidemiology.

OBJECTIVE: To determine gender differences in the prevalence, survival rates, and management of noncognitive behavioral problems of patients with Parkinson's disease (PD) in nursing homes (NH). METHODS: We performed an observational study on 24,402 residents with PD using the Systematic Assessment and Geriatric drug use via Epidemiology (SAGE) database collected from the Minimum Data Set on a cross-section of over 400,000 NH residents in five US states. Gender differences in behavior were used to predict differences in pharmacologic and nonpharmacologic therapies using logistic regression. Similar analyses were done to evaluate gender differences in 1-year survival rates among patients with PD with and without behavioral problems. RESULTS: 36% of men and 33% of women exhibited behavioral problems. Wandering, verbal and physical abusiveness, and inappropriate behavior tended to be more common in men, especially among PD residents with severe cognitive impairment. Hallucinations and delusions were equally prevalent between genders and depressive symptoms were more common in women. Regardless of behavioral manifestation, men were more likely to receive antipsychotic drugs, whereas women were more likely to receive antidepressants. This gender difference in treatment was also widest among the severely demented group. Although women lived longer, no difference in survival curves were noted between PD residents with and without behavioral problems. CONCLUSION: Gender appears to play an important role in determining the frequency and treatment of behavioral problems of NH residents with PD.

Activities of Daily Living↗

Early behavior problems as a predictor of later peer group victimization: moderators and mediators in the pathways of social risk.

This study is a prospective investigation of the predictive association between early behavior problems (internalizing, externalizing, hyperactivity-impulsiveness, immaturity-dependency) and later victimization in the peer group. Teacher ratings of the behavioral adjustment of 389 kindergarten and 1st-grade children (approximate age range of 5 to 6 years-old) were obtained, using standardized behavior problem checklists. These ratings predicted peer nomination scores for victimization, obtained 3 years later, even after the prediction associated with concurrent behavior problems was statistically controlled. Further analyses suggested that the relation between early behavior problems and later victimization is mediated by peer rejection and moderated by children's dyadic friendships. Behavior problems appear to play an important role in determining victimization within the peer group, although the relevant pathways are complex and influenced by other aspects of children's social adjustment.

Aggression↗

Association of 5HT2A receptor gene polymorphism and alcohol abuse with behavior problems.

This study investigated the association between T/C polymorphism, at position 102, of the 5-hydroxytryptamine 2A receptor gene and alcoholism with and without behavior problems. Eighty-five subjects (45 men, 40 women) with alcohol abuse, 75 subjects (51 men, 24 women) with alcohol dependence, and 70 normal control subjects (21 men, 49 women) participated in the study. The results show that the frequency of the homozygous T102 genotype was significantly lower in the group of male alcohol abuse with behavior problems than in the female group (chi(2) = 4.072, df = 1, P < 0.05) and the allele frequency of T102 was also lower in the male group than in the female group (chi(2) = 4.187, df = 1, P < 0.05). Of the male alcohol abuse subjects, the group with behavior problems was found to have lower frequencies of the T102 allele than the group without behavior problems (chi(2) = 4.328, df = 1, P < 0.05). In conclusion, this study demonstrates that alcoholism is heterogeneous and male alcohol abuse with behavioral problems was associated with T/C 102 polymorphism of the 5HT2A receptor gene. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:797-800, 2000.

Alcoholism↗

Effects of setting events on the problem behavior of students with severe disabilities.

Two studies analyzed the effects of preceding setting events on the problem behavior of students with severe disabilities. Using ABAB withdrawal designs, the occurrence versus nonoccurrence of preceding setting events was analyzed in relation to the frequency of problem behavior. Data were collected throughout a student's school day, with interventions focusing upon the elimination of setting events that occurred before school. The results indicate that (a) the occurrence of preceding setting events was related to higher frequencies of problem behavior and (b) interventions designed to eliminate preceding setting events were consistently associated with low frequencies of problem behavior.

Activities of Daily Living↗

Developmental course of problem behaviors in adolescent adoptees.

OBJECTIVE: To determine the 3-year developmental course of problem behaviors and competencies in intercountry adoptees in adolescence and to determine the role of ethnicity and early adverse environmental influences on the development of problem behaviors. METHOD: In this prospective study, a sample of 1,538 intercountry adoptees, aged 11 to 14 years at initial assessment and 14 to 17 years at follow-up, were assessed with the Child Behavior Checklist (CBCL) at both occasions. RESULTS: Across the follow-up interval there was an increase in problem behaviors and a decrease in competencies. Increases in problem scores were greatest for the CBCL scales Withdrawn and Delinquent Behavior. These findings contrasted with the results from a longitudinal study of an epidemiological sample of children from the general population. The increase in problem scores could not be attributed to the age of the child at placement, the medical condition at placement, early neglect or abuse, or racial antagonism. CONCLUSION: In contrast with their agemates from the general population, intercountry adoptees showed an increase in maladaptive functioning in adolescence. Because early adverse influences were not responsible for the increase of problems, it was concluded that other factors pertaining to adolescent development interact negatively with adoption-specific factors that render individuals vulnerable to deviation from the normal developmental pathway.

Adolescent↗