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PubMedDate not supplied

Time for change: the role of nonpharmacological interventions in treating behavior problems in nursing home residents with dementia.

This paper discusses the etiology of behavior problems in dementia and concludes that a substantial portion of such behaviors arise when care does not appropriately address the underlying causes. The needs of persons with dementia are frequently unrecognized and not addressed because of a combination of factors including communication problems, the multidimensional nature of etiologies and needs, the discounting of the needs of the patient with dementia, an environment that lacks knowledge and resources, and the improper allocation of resources on the part of policy makers, clinicians, and caregivers. The paper delineates some of the steps that are needed to move toward a more appropriate treatment of persons with dementia who manifest behavior problems.

Aged↗

PubMed2002

Assessing emotional and behavioral problems in children with intellectual disability: revisiting the factor structure of the developmental behavior checklist.

The objective of the reported study was to reassess the factor structure of the Developmental Behaviour Checklist (DBC) in a large cross-cultural sample representing all levels of intellectual disability. Parent and teacher DBC ratings on a combined sample of 1536 Dutch and Australian children and adolescents (ages 3-22) with mild to profound intellectual disability were used. Principal components analyses produced five subscales: Disruptive/Antisocial, Self-Absorbed. Communication Disturbance, Anxiety, and Social Relating, explaining 43.7% of the total variance. Internal consistencies of these subscales ranged from .66 to .91. The revised factor structure of the DBC appears to be an improved and useful tool for assessing emotional and behavioral problems in children with intellectual disabilities.

Adolescent↗

PubMed2005

The prevalence of teachers who bully students in schools with differing levels of behavioral problems.

OBJECTIVE: This study looked for a relationship between the prevalence of teachers who bully students and school behavioral problems reflected in suspensions from school. METHOD: A convenience sample of 214 teachers answered an anonymous questionnaire about their perceptions of teachers who bully students and their own practices. Teachers were grouped into whether they taught at schools with low, medium, or high rates of suspensions. Analyses of variance were used to analyze continuous variables, and chi-square statistics were used to study categorical variables. RESULTS: Teachers from schools with high rates of suspensions reported that they themselves bullied more students, had experienced more bullying when they were students, had worked with more bullying teachers over the past 3 years, and had seen more bullying teachers over the past year. CONCLUSIONS: These findings suggest that teachers who bully students may have some role in the etiology of behavioral problems in schoolchildren.

Adult↗

PubMed2002

Emotional and behavioral problems in children and adolescents with and without intellectual disability.

BACKGROUND: The main objective of this study was to assess and compare the prevalence of a wide range of emotional and behavioral problems in children with and without intellectual disability (ID). METHODS: We studied 1,041 non-residential children randomly selected from special schools for educable (IQ 60 to 80) and trainable (IQ 30 to 60) children without severe additional physical or sensory impairments, and compared them to 1,855 children randomly selected from the general population (both ages 6 to 18). Parents completed the Child Behavior Checklist (CBCL), and teachers the Teacher's Report Form (TRF). RESULTS: Controlling for sex, age, and socioeconomic status, we found that both educable and trainable children had significantly higher mean scores on all CBCL and TRF scales than children without ID, except for trainable children on the scales Anxious/Depressed and Somatic Complaints. Almost 50% of children with ID had a Total Problem score in the deviant range compared to about 18% in children without ID. Compared to children without ID, the most prominent problem behaviors of educable children were Social Problems, Attention Problems, and Aggressive Behavior, and trainable children had an increased risk for Social Problems, Attention Problems, Withdrawn and Thought Problems. CONCLUSIONS: Elevated scale scores reflected differences between children with and without ID over a broad range of items, and not solely on items more likely to be related to developmental delay. Therefore, problem areas covered by the items in these scales deserve special attention in the mental health care of children with ID.

Adolescent↗

PubMed1975

Teacher race, student race, and the Behavior Problem Checklist.

The ratings of 458 fourth- and fifth-grade boys were investigated to determine whether or not scores on the Behavior Problem Checklist vary systematically with teacher or student race. Analyses of the data for conduct problems, inadequacy-immaturity, and socialized delinquency indicated that white teachers demonstrate a strong tendency to rate black children as more deviant and white children as less deviant when contrasted with the ratings of black teachers. The ratings of black teachers were found not to vary with student race. No differences among any of the variables were found with regard to personality problems. Possible explanations for the results are discussed, along with implications for the use of the Behavior Problem Checklist in the field.

Attitude↗

PubMed2002

The interactive effects of infant activity level and fear on growth trajectories of early childhood behavior problems.

The current study examined the interactive effects of infant activity level and fear on growth trajectories of behavior problems in early childhood (age 4 to 8 years) using maternal ratings. The sample was drawn from the National Longitudinal Survey of Youth (NLSY) and included children who were between 1 and 11 months in 1986. Findings suggested that boys characterized by high activity level and low levels of fear in infancy escalated in both externalizing and internalizing symptoms. Also, boys characterized by high fear and low activity level increased in internalizing symptoms and these effects seemed to be specific to depression rather than anxiety. Temperament did not predict escalation in externalizing symptomatology for girls, but low levels of fear predicted increases in internalizing symptoms. There was also evidence for a decline in depression specific symptoms for girls characterized by high fear and low activity in infancy. These findings suggest the importance of examining interactive models of temperament risk and considering gender specific pathways to behavior problems.

Age Factors↗

PubMed1999

Evaluation of emotional and behavioral problems in language impaired children using the Child Behavior Checklist.

Speech and language impaired children are at special risk for developing psychiatric disorders. Attention deficit, aggressive behaviour as well as overanxiety and excessive shyness have been reported in speech and language impaired children. The purpose of this study was to determine how the Child Behavior Checklist (CBCL) could be used as a screening instrument in language impaired children. In a sample of 83 language impaired children, emotional and behavioural problems were evaluated using the CBCL. Independent of this assessment, DSM-IV diagnoses were established for all children. Sixty-six of the 83 children had a psychiatric diagnosis. The use of the Total Behavior Problem score (TBP) as a global measure of behavioural disturbance showed that children with a psychiatric diagnosis had significantly higher scores on the TBP score than children without a psychiatric diagnosis. The specificity of the TBP was 88.2%, the sensitivity 75.8%, and the false classification rate 21.6%. The most frequently reported behavioural disturbances were problems on scale VI ("Attention Problems"-39 children) and on scale I ("Withdrawn"-32 children). A small group of children with a receptive language disorder and pronounced compulsive behavioural problems had elevated scores on scale V ("Thought Problems").

Affect↗

PubMed2000

Cognitive and behavioral problems in children with centrotemporal spikes.

Atypical features in benign epilepsy of childhood with centrotemporal spikes (BECTS) are not uncommon. There are children with BECTS who do not have a benign outcome in terms of neuropsychologic functioning. BECTS have been linked with Landau-Kleffner syndrome (LKS) and continuous spikes and waves during slow sleep (CSWS). At the Medical College of Georgia from January 1988 to June 1999, 78 children, ages 2-16 years, were identified to have electroencephalogram evidence of centrotemporal spikes. Their medical records were reviewed for developmental history, behavioral problems, and school performance. Children with structural lesions/other epileptic syndromes were excluded. Fifty-six demonstrated a history of clinical seizures compatible with BECTS and 22 demonstrated centrotemporal spikes without clinical seizures. Among all children with centrotemporal spikes, 9% (n = 7) were diagnosed with mild intellectual disability (intelligence quotient < 70), 10% (n = 8) with borderline functioning, 31% (n = 24) with behavioral problems, and 17% (n = 13) with specific learning disabilities. Three children with BECTS experienced language delay and regression. Seizure control for BECTS usually is achieved without much difficulty, with excellent long-term prognosis. However, the data presented indicate that a large number of BECTS patients exhibit learning or behavior problems that require intervention. A small number may demonstrate language outcome similar to children with LKS and CSWS.

Adolescent↗

PubMed1999

Prepubertal boys' sexual behavior and behavior problems.

The increasingly early initiation of penetrative sexual practices and the implication for prevention of HIV and sexually transmitted diseases requires the study of childhood sexual behavior and its determinants. In adolescence, early sexual initiation is associated with other "problem behaviors" (Jessor & Jessor, 1977). To explore an analogous association for the middle childhood years, we studied 126 boys aged 5 to 11 years at increased risk for the development of conduct-disorder-related behavior with the Child Behavior Checklist (CBCL)/4-18 (Achenbach, 1991) and reevaluated 112 of them 15 months later. At both time points, the boys scored higher on the Sex Problems scale as well as on the nonsexual CBCL scales than Achenbach's nonclinical norm sample. Within the at-risk sample, the Sex Problems scale was significantly related to externalizing problem behaviors, but also to the other CBCL scales of behavioral/emotional problems. These data point to childhood precursors of the association observed by Jessor and Jessor (1977) in adolescence.

Child↗

PubMed2005

When a parent has a stroke: clinical course and prediction of mood, behavior problems, and health status of their young children.

BACKGROUND AND PURPOSE: The purpose of this research was to describe the clinical course of children's functioning (depression, behavioral problems, and health status) during the first year after parental stroke and to determine which patient-, spouse-, or child-related factors at the start of inpatient rehabilitation can predict children's functioning after parental stroke at 1-year poststroke. METHODS: Interviews with 82 children (4 to 18 years of age) and their parents (n=55) shortly after admission to a rehabilitation center, 2 months after discharge from inpatient rehabilitation, and 1 year after stroke. Depression was assessed using the Children Depression Inventory, behavioral problems with the Child Behavior Check List, and health status with the Functional Status II. Potential predictors were gender and age (child), activities of daily living disability and communication ability (patient), and spouse's depression and perception of the marital relationship. RESULTS: At the start of the stroke patient's rehabilitation, 54% of the children had > or =1 subclinical or clinical problems, which improved to 29% 1 year after stroke. Children's functioning 1 year after stroke could best be predicted by their functioning at the start of rehabilitation. Spouse depression and perception of marital relationship were also significant predictors. A total of 28% to 58% of the variance in children's functioning could be explained. CONCLUSIONS: Children's functioning after parental stroke improved during the first year after stroke. Identifying children at risk for problems 1 year after stroke requires assessment of children's functioning and the healthy spouse's depressive symptoms and perception of the marital relationship at the start of rehabilitation. This demonstrates the need for a family-centered approach in stroke rehabilitation.

Activities of Daily Living↗

PubMed2005

Patterns of risk and trajectories of preschool problem behaviors: a person-oriented analysis of attachment in context.

A small proportion of children exhibit extreme and persistent conduct problems through childhood. The present study employed the multiple-domain model of Greenberg and colleagues as the framework for person-oriented analyses examining whether parent-child attachment combines with parenting, family ecology, and child characteristics in particular configurations of risk that are linked to this problematic developmental pathway. Using prospective data from a community sample of adolescent mothers and their children, latent variable growth mixture modeling identified a normative trajectory with declining problem behaviors during the preschool period. Consistent with research on early-starter pathways, a distinct group of children featured a higher intercept and a positive slope, indicating an escalation in disruptive behaviors. Attachment security played a role in defining specific risk profiles associated with the probability of exhibiting this problem trajectory. Given particular patterns of risk exposure, secure attachment served a protective function. Avoidant, but not disorganized, attachment was associated with significantly higher likelihood of the disruptive problem trajectory. The results also indicated the general accumulation of risk was detrimental, but the particular configuration of risk made a difference. Overall, the findings suggest early attachment operates in conjunction with personal and contextual risk to distinguish the development of later problem behaviors.

Adolescent↗

PubMed1994

[Relationship between behavioral problems and cognitive status in Alzheimer type and mixed Alzheimer and vascular dementia].

To investigate the relationship between troublesome behavior and cognitive status in Alzheimer type dementia (DAT), and to know whether the addition of cerebrovascular ischemia modifies that relationship, we studied behavioral and cognitive data from a clinical series of 57 DAT patients (mean age: 83.4 yrs) and 31 patients with mixed Alzheimer and vascular dementia (MIX) (mean age: 83.4 yrs). All subjects were ambulatory and were recruited from among patients having been admitted to our affiliated nursing home. None of them had any serious systemic diseases. The Dementia Behavior Disturbance scale (DBD), originally developed by Baumgarten et al, and the Mini-Mental State (MMS) were used for the evaluation of behavioral problems and cognitive status, respectively. In the DAT group, a significant correlation was recognized between DBD and MMS scores. In the MIX group, however, DBD scores did not correlate with MMS scores. Among patients having MMS scores greater or equal to 20, those with MIX had higher DBD scores (mean 19.3) than those with DAT (mean 13.7), although MMS scores in these two subgroups were comparable. These findings suggest that in DAT, behavioral problems increase in conjunction with cognitive impairments. However, with the addition of cerebrovascular ischemia to Alzheimer pathology, behavioral impairments may progress independently of cognitive decline, with more frequent presentation of troublesome behaviors in the early stage of dementia.

Aged↗

PubMed1999

A two-year longitudinal study of neuropsychological and cognitive performance in relation to behavioral problems and competencies in elementary school children.

Despite interest in early neuropsychological status as a possible contributor to children's behavioral development, prospective longitudinal investigations of neuropsychological measures in relation to later behavioral outcomes in childhood are few. A 2-year longitudinal study in a nonselected childhood sample is reported. The study tested the influence of early neuropsychological performance (verbal fluency, mental inhibitory control, and visual spatial ability) on later childhood behavioral problems and social competency. Regular education children (n = 235) were assessed at three time points 1 year apart. To control for autocorrelation of outcome measures, Time 1 behavior was partialed while testing the effects of Time 1 neuropsychological scores on Time 3 outcome. To control for autocorrelation of neuropsychological scores, Time 2 scores were partialed while testing the predictive effect of Time 1 scores on Time 3 outcome. Both sets of regression models suggested modest but statistically significant effects for inhibitory control and verbal fluency, but not IQ, reading, or visual spatial ability, on behavioral outcome. Study results are consistent with a modest causal effect of selected neuropsychological skills on later behavioral adjustment. The findings support theories that implicate subtle neuropsychological dysfunction in the development of behavioral problems in childhood.

Child↗

PubMed1998

The influence of distress on mothers' and fathers' reports of childhood emotional and behavioral problems.

This study examined the effect of parental distress on mothers' and fathers' reports of children's emotional and behavioral problems. The subjects were the parents of 696 children aged 10 to 11 or 14 to 15 years living in two-parent families in the community. The study utilized an extended version of the model previously employed by Fergusson, Lynskey, and Horwood (1993) to examine the impact of maternal depression on mothers' reports of children's behavior. In the present study, the extended model was used to assess the impact of distress on reports of childhood externalizing and internalizing problems obtained from both mothers and fathers. The results suggested that distress had little influence on mothers' or fathers' reports of childhood behavior problems. It is concluded that in community studies the size of any bias in mothers' and fathers' reports of childhood behavior problems due to parental distress is likely to be very small and of little clinical significance.

Adolescent↗

PubMed1992

Specialized treatment for behavior problems of institutionalized persons with mental retardation.

The extent of use and effectiveness of special treatment options (in-house behavior shaping units, specialized outside referral agencies, and mobile intensive treatment teams) in dealing with behavior problems of persons with mental retardation was determined. A survey was completed by 144 institutions throughout the United States; 86% of all facilities recognized a need for special treatment options to deal with clients who had severe behavior problems. Sixty-eight percent of the institutions had presently or in the recent past used at least one of the three treatment options. Comparisons of these options in terms of perceived effectiveness, length of intervention, and type of problem addressed were reported.

Affective Symptoms↗

PubMedDate not supplied

Protective longitudinal paths linking child competence to behavioral problems among African American siblings.

A 4-wave longitudinal design was used to examine protective links from child competence to behavioral problems in first- (M=10.97 years) and second- (M=8.27 years) born rural African American children. At 1-year intervals, teachers assessed child behavioral problems, mothers reported their psychological functioning, and both mothers and children reported parenting practices. Structural equation modeling indicated that child competence was linked with residualized positive changes in mothers' psychological functioning from Wave 1 to Wave 2. Mothers' psychological functioning and child competence at Wave 2 forecast involved-supportive parenting at Wave 3, which was associated negatively with externalizing and internalizing problems at Wave 4. The importance of replicating processes leading to outcomes among children in the same study is discussed.

Black or African American↗

PubMed1995

Problem behavior in early and middle childhood: an initial behavior genetic analysis.

Twin samples were used to estimate the relative importance of genetic and environmental influences on problem behavior in children, assessed by the Child Behavior Checklist (CBCL). For the younger cohort, mothers completed the CBCL/2-3, while for the older cohort the CBCL/4-18 was used. Nearly half of the older sample had also been assessed with the questionnaire for younger children at a prior date, providing tentative answers regarding continuity and change in the etiology of problem behavior. Results suggested that shared environmental influences may be more important in early childhood than in middle childhood, while the reverse holds for genetic influences.

Child↗

PubMed1996

Pattern of preschool behavior problems in New Zealand, using the Behavior Check List.

OBJECTIVE: The main aim of the study was to identify the pattern of behaviour problems in preschool children to enable early recognition and intervention. METHODOLOGY: Three hundred and twenty children, in eight randomly selected preschool centres, aged between 2.5 and 5 years, were included in the study. Parents completed the Behaviour Check List (BCL),a screening measure for preschool behaviour problems. RESULTS: Dependency, temper tantrums, and being difficult to manage were the commonly rated symptoms when moderate-severe problems were examined. Developmental problems decreased with increasing age, while relationship problems and worries that were cognitively mediated worsened. There were no major differences in the patterns between boys and girls. On cross-cultural comparison, parents in New Zealand rated their children lower on the BCL compared to those in the UK. Factor analysis of the BCL yielded seven factors. The two main factors 'predominantly conduct' and 'predominantly emotional' consisted of a mixture of conduct (difficulty in managing, temper tantrums, sibling rivalry) and emotional (unhappy mood, worry, fears) problems. The other five factors were related to developmental problems. CONCLUSIONS: These results help clinicians identify the emerging pattern of preschool behaviour problems that change with increasing age and vary with differing cultures. Categorical presentation of preschool behaviour problems support the view that they should be included in a classification system.

Adult↗