[Feeding behavior problems in children].
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OBJECTIVES: To assess the use of the Family APGAR instrument as a supplement to usual clinical methods for the detection of psychosocial problems in children and to evaluate the relationship between the Family APGAR and physician diagnosis and elevated Child Behavior Checklist (CBCL) scores. DESIGN: Cross-sectional. SETTING: Ambulatory care center of a community-based, university-affiliated family medicine training program. SUBJECTS: One hundred fifty-two parents of children aged 3 to 16 years. MAIN OUTCOME MEASURES: Family functioning was considered poor if Family APGAR scores were 5 or less. For the CBCL, sum total T scores greater than the 90th percentile for nonreferred children were considered clinically significant. Physicians used a checklist to indicate the presence of psychosocial problems or family dysfunction. RESULTS: Agreement between the Family APGAR scores and the physician's detection of child psychosocial problems was weak (kappa = 0.23). There was no relationship between the Family APGAR scores and physician perception of family dysfunction (kappa = -0.05). Although agreement between the Family APGAR and CBCL classifications was weak (kappa = 0.20), families with low Family APGAR scores were more than twice as likely to have children with clinically significant CBCL scores than those with higher scores (risk ratio = 2.08; 95% confidence interval = 1.02 to 4.24). CONCLUSIONS: The relationships among the Family APGAR and CBCL scores and physician detection of child psychosocial problems were weak. Child psychosocial problems were more than twice as likely to be present when the Family APGAR score was low. These findings suggest that family functioning is related to child psychosocial problems, but that the Family APGAR may not improve screening for child psychosocial problems.
This article reviews recent attachment-related studies of early aggression. That aggressive behavior toward peers is related to disorganized or controlling patterns of attachment behavior toward parents but not to avoidant or ambivalent patterns. Longitudinal attachment studies indicate that risk factors identified in cross-sectional studies of aggressive school-age children, such as family adversity, parental hostility, parental depression, and child cognitive deficits, are already evident in infancy and predictive of later aggression, before the onset of coercive child behavior. In infancy, these risk factors are associated with disorganized attachment behaviors toward the caregiver characterized by signs of fear or dysphoria, irresolvable conflict between opposing behavioral tendencies, and elevated cortisol levels after separation. Disorganized attachment behaviors, in turn, predict aggression in school-age children with other family factors controlled.
Mothers, teachers, and assistant teachers completed the Richman Behavior Checklist (BCL) at ages 2 and 3 years and the Achenbach Child Behavior Checklist for Ages 2-3 (CBCL 2-3) at 3 years for a large sample of low birth weight, premature children. Interinstrument correlations for total scores were moderate, higher for teachers and assistant teachers than for mothers, with moderate temporal stability for BCL scores. Interrater agreement for either total scores or classifications of clinically significant scores was moderately high between teachers and assistant teachers only, and children identified as disturbed by mothers versus teachers represent almost nonoverlapping groups. Furthermore, many more children were identified as disturbed using the BCL. The most powerful predictors of mothers' total CBCL 2-3 scores were HOME Inventory scores and self-reported depression. The use of these scales in clinical and research contexts is discussed.
Previous studies have emphasized the importance of rater issues in studying the etiology of variation in internalizing and externalizing problems in children. Earlier results indicate only moderate agreement between parents, and assume that parents assess a specific aspect of their child's behavior. In comparable samples of younger children, additive genetic effects are the main factor explaining individual differences in both internalizing and externalizing behavior. It is unknown whether this pattern of rater influences and variance decomposition will be consistent in older children. Child Behavior Checklists (Achenbach, 1991), completed by both parents, were collected in a sample of 2956 Dutch 10-year-old twin pairs. The etiology of individual differences in internalizing and externalizing syndromes was examined using a model that corrected for possible rater bias, rater-specific effects and unreliability. The best fitting model suggested that disagreement between the parents is not merely the result of unreliability and/or rater bias, but each parent also provides specific information from his/her own perspective on the child's behavior. Significant influences of additive genetic, shared environmental and unique environmental factors were found for internalizing and externalizing syndromes.
Research examining teachers' judgments of children's behavior has typically used archival data, staged videos, or written vignettes describing children's behavior. The main advantage of using staged videos and written vignettes has been that those methodologies have led to well-controlled studies. The main disadvantage is that little is known about teachers' perceptions of the problems of children in their own classrooms. In the current study. 111 first-, second-, and third-grade teachers described children in their classrooms whose behavior concerned them. Teachers identified significantly more children with externalizing problems than internalizing problems and significantly more boys than girls as having problems that concerned them. However, when teachers identified children as having internalizing problems, they were just as likely to judge them as needing referral as children with externalizing problems. Similarly, when teachers judged children to have problems that concerned them, they were just as likely to judge girls as needing referral as boys.
The severe aggression and noncompliance of a profoundly retarded blind male were subjected to extensive behavioral assessment in order to identify controlling variables. The assessment, conducted across settings and therapists, suggested that these inappropriate behaviors functioned to avoid or terminate nonpreferred activities. Intervention consisted of manual guidance when there was noncompliance with instructions and edible reinforcement upon compliance; there were no direct contingencies for the inappropriate behaviors. Treatment procedures were implemented in a multiple baseline design across therapists and settings. Results show that the intervention consistently increased compliance, with concurrent decreases in inappropriate behaviors. Edible reinforcement and neuroleptic medication were withdrawn systematically with no loss of therapeutic gains. Family members and school personnel were trained to use the intervention procedures. Results are discussed in terms of functional assessment, response covariation, compliance training, parent and staff training, and behavioral assessment of the effects of neuroleptic medication.
BACKGROUND: Four types of agitation have been identified: physically aggressive behaviors, physically nonaggressive behaviors, verbally aggressive behaviors, and verbally nonaggressive behaviors. These pose a major challenge to caregivers and are sometimes indicators of the emotional state of the older person. Longitudinal changes in these four subtypes of agitated behaviors were examined. METHODS: One hundred and four community-dwelling participants of five senior day care centers (mean age = 79) were followed up for 2 years. Their agitation was assessed, as was their cognitive functioning, affect, and medical functioning. RESULTS: Although physically nonaggressive, physically aggressive, and verbally aggressive behaviors increased significantly over 2 years, verbally nonaggressive behaviors did not show significant changes over time. These patterns can be partially explained by the relationship between the different types of agitation and cognitive functioning. Increases in physically nonaggressive behaviors from start to end of the 2 years were predicted by greater cognitive impairment at baseline and by receiving a smaller number of medications at baseline. Increases in verbally aggressive behaviors and in physically aggressive behaviors during the study period correlated significantly with a greater decline in cognitive functioning and increased depression at baseline. In addition, increases in physical aggression were correlated with greater cognitive impairment at baseline. CONCLUSIONS: The course of change for each type of agitation was unique. The relationships between inappropriate behaviors, cognitive functioning, physical health, and depression over time are complex and vary by type of agitation.
Folstein's Mini Mental State Exam, a test assessing the capacity to perform novel and/or repetitive motor tasks (Behavioral Dyscontrol Scale) and a brief measure of working memory were used in a sample of 50 male Veterans Affairs geriatric clinic patients who ranged in age from 63 to 105 (mean, 80.1). The purpose of this study was to attempt to predict the patients' capacity to regulate their behavior independently. We hypothesized that frontal lobe disorders often impair a patient's ability to function autonomously and that the Behavioral Dyscontrol Scale, a measure of frontal lobe impairment, would best predict the capacity for independent regulation of purposeful behavior. Therefore, we examined the relationship of the Behavioral Dyscontrol Scale with spouses' and caregivers' ratings of patients' independent living skills, and with behaviors that interfere with independent functioning. The results of hierarchial regression analyses indicated that the Behavioral Dyscontrol Scale was the only predictor of functional autonomy and was the best predictor of both impulsivity and apathy among geriatric patients. The Behavioral Dyscontrol Scale appears to assess a different functional domain than do the MMSE and similar measures, which rely heavily on the evaluation of orientation and gross cognitive status.
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