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PubMed2003

Familias Unidas: the efficacy of an intervention to promote parental investment in Hispanic immigrant families.

This paper reports a test of the efficacy of Familias Unidas, a Hispanic-specific, ecologically focused, parent-centered preventive intervention, in promoting protection against and reducing risk for adolescent behavior problems. Specifically, the intervention was designed to foster parental investment, reduce adolescent behavior problems, and promote adolescent school bonding/academic achievement, all protective factors against drug abuse and delinquency. One-hundred sixty seven Hispanic families of 6th and 7th grade students from three South Florida public schools were stratified by grade within school and randomly assigned to intervention and no-intervention control conditions. Results indicated that Familias Unidas was efficacious in increasing parental investment and decreasing adolescent behavior problems, but that it did not significantly impact adolescent school bonding/academic achievement. Summer-vacation rates of adolescent behavior problems were six times higher in the control condition than in the intervention condition. Furthermore, change in parental investment during the intervention was predictive of subsequent levels of adolescent behavior problems. The findings suggest that Familias Unidas is efficacious in promoting protection and reducing risk for adolescent problem behaviors in poor immigrant Hispanic families.

Adolescent↗

PubMed2001

Feeding Problems in Infants and Children.

This article focuses on factors related to decreased food intake of infants and children, but does not address anorexia or bulimia nervosa. The nature of feeding problems may be behavioral, organic, or a mixture of both. Behavioral problems that affect intake have their roots in 1) parental or cultural expectations for food intake and body habit, 2) parental anxiety about weight gain in a vulnerable child or insecurity about parental skills, 3) power struggles between parent and child that manifest in eating habits, 4) conditions that may have enhanced the gag reflex, such as prolonged orotracheal intubation or a nasogastric tube, 5) failure to establish links between hunger, food intake, and satiety in infants who had not been fed orally for a relatively prolonged period of time at a critical age, and 6) anxiety or depression. Organic causes that lead to decreased food intake include swallowing problems (neurologic or conditioned hypersensitive gag, structural anomalies of the oropharynx, dyscoordinated swallow, painful swallow, and obstructed swallow ), respiratory distress, excessive fatigability (heart failure, respiratory failure), and lack of appetite (many chronic systemic illnesses). At particular risk for feeding problems are infants of premature birth, children with craniofacial anomalies, those with certain genetic syndromes, and those with neurologic involvement. An evaluation by specialists is recommended for children with obvious behavioral problems but for whom the usual recommendations have failed and for those in whom symptoms cannot be explained solely by behavioral issues or in whom organic causes are suspected. The evaluation preferably should be performed by a team specialized in pediatric feeding disorders or otherwise by an occupational therapist or speech pathologist with expertise in the area of feeding.

Journal Article↗

PubMed2004

Perceived support in sibling relationships and adolescent adjustment.

BACKGROUND: Siblings may support each other, but also reveal fierce rivalry and mutual aggression. Supportive sibling relationships have been linked to the development of psychosocial competence of children. In the present longitudinal study, we will focus on the development of perceived support in sibling dyads and on the influence of sibling support and sibling problem behavior on psychosocial adjustment in adolescence. METHOD: In a three-wave longitudinal sample of 285 Dutch families with two adolescent children (11- to 15-year-olds), these two siblings judged the support perceived from each other. In addition, they themselves and their parents judged their internalizing and externalizing problem behaviors. The relation of sibling support and sibling problem behavior with internalizing and externalizing problem behaviors was examined while controlling for support from parents and friends and, over time, controlling for the autoregressive effects of problem behavior. RESULTS: Support perceived from a sibling is mostly negatively related to externalizing problems; sibling problem behavior is strongly related to internalizing problems. Differential developmental trajectories of adolescents' adjustment are associated with siblings' support and problem behavior. CONCLUSION: The results indicate that adolescents' relationships with both older and younger siblings are characterized by modeling processes.

Adolescent↗

PubMed1995

Comparison of diagnostic criteria for attention deficit disorders in a German elementary school sample.

OBJECTIVE: This study compares teacher-reported prevalence rates for disruptive behavior disorders using DSM-IV, DSM-III-R, and DSM-III criteria within the same population of elementary school students and examines the relationships between DSM "subtypes" and academic performance, perceived behavior problems, and demographic variables. METHOD: Teacher rating scales were obtained on 1,077 students in five rural and five urban public schools in Regensburg, Germany. Rating scales included DSM-III-R items (attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder), DSM-IV items (attention-deficit/hyperactivity disorders [AD/HDs], oppositional defiant disorder), and DSM-III items (attention deficit disorder, with and without hyperactivity). Factor analyses of significance were performed. RESULTS: Overall prevalence for attention deficit disorders increased from 9.6% (DSM-III) to 17.8% (DSM-IV) primarily because of new cases identified as AD/HD-AD (inattentive type) and to a lesser degree, AD/HD-HI (hyperactive-impulsive type). Inattention in any subtype was associated with academic problems, and perceived behavior problems were associated with more than 80% of the cases that included hyperactivity-impulsivity. DSM-IV AD/HD subtypes showed significant behavioral, academic, and demographic differences. CONCLUSION: Application of DSM-IV criteria increased total AD/HD prevalence rates by 64% and identified the majority of children with academic and/or behavioral dysfunction. The data show significant heterogeneity between the subtypes and imply that many children screened into these subtypes require further evaluation to ensure appropriate management.

Achievement↗

PubMed1994

Adolescent substance use and codependence.

This research evaluated the extent to which parental codependence was associated with adolescent substance use and other adolescent problem behaviors. The sample was comprised of 293 adolescents and their parents who were interviewed by trained intake workers. Using LISREL modeling, we found that the number of adolescent problem behaviors was associated with parental persecuting, suffering, and rescuing behaviors. Net of problem behaviors, adolescent substance use was associated with parental suffering but not with parental persecution or rescuing. As expected, there was a strong association between adolescent problem behaviors and substance use. The associations of substance use and problem behaviors with codependence were not moderated by religious preference or by being a member of a religion that teaches abstinence.

Acting Out↗

PubMedDate not supplied

A prospective study of the effects of marital status and family relations on young children's adjustment among African American and European American families.

The present study investigated the effects of divorce and family relations on young children's development prospectively, using an ethnically diverse sample of approximately 300 low-income families. We also were able to examine the moderating effects of ethnicity on child adjustment in always two-parent, to-be-divorced, already-divorced, and always single-parent families. Results indicated that to-be-divorced European American and African American families demonstrated higher rates of preschool-age behavior problems, and already-divorced families showed similar trends. Parental conflict and behavior problems accounted for predivorce differences in child behavior problems, whereas rejecting parenting accounted for differences in problem behavior between always single-parent and always two-parent families. The results are discussed in terms of the importance of ethnicity in influencing young, low-income children's adjustment to different family structures.

Adolescent↗

PubMed2005

Investigating the effects of communication problems on caregiver burden.

OBJECTIVE: The goal of this study was to explore the relationship between communication problems associated with dementia and caregiver burden, within the context of problem behaviors and cognitive and functional abilities of the care recipient. METHODS: A scale on communication problems associated with dementia was developed and administered to 89 family caregivers. Participants also completed measures of care-recipient cognitive and functional status, problem behavior, and caregiver burden (demand, stress, and objective burden). RESULT: Analyses using structural equation modeling showed that care-recipient cognitive and functional status indirectly predicted problem behaviors via communication problems. The status indicators also directly predicted demand burden. In addition, problem behaviors mediated the relationship between communication problems and all forms of burden. DISCUSSION: The study findings not only lend further support to the existing literature that has documented problem behaviors as strong predictors of burden but also emphasize the importance of communication problems in the caregiving process.

Adult↗

PubMed2005

Relationship of corporal punishment and antisocial behavior by neighborhood.

OBJECTIVES: To examine the relationship of corporal punishment with children's behavior problems while accounting for neighborhood context and while using stronger statistical methods than previous literature in this area, and to examine whether different levels of corporal punishment have different effects in different neighborhood contexts. DESIGN: Longitudinal cohort study. SETTING: General community. PARTICIPANTS: 1943 mother-child pairs from the National Longitudinal Survey of Youth. MAIN OUTCOME MEASURE: Internalizing and externalizing behavior problem scales of the Behavior Problems Index. RESULTS AND CONCLUSIONS: Parental use of corporal punishment was associated with a 0.71 increase (P<.05) in children's externalizing behavior problems even when several parenting behaviors, neighborhood quality, and all time-invariant variables were accounted for. The association of corporal punishment and children's externalizing behavior problems was not dependent on neighborhood context. The research found no discernible relationship between corporal punishment and internalizing behavior problems.

Adult↗

PubMed1997

Five years after child sexual abuse: persisting dysfunction and problems of prediction.

OBJECTIVE: To assess change in behavior, depression, and self-esteem in sexually abused children after 5 years and to determine which factors predict later functioning. METHOD: Sixty-eight of 84 children and their nonoffending parents were reassessed after 5 years for depression, self-esteem, and behavior problems in the children; parental mental health; and family functioning. RESULTS: There were no significant changes in depression, self-esteem, or behavior over 5 years. Forty-three percent of the children were now sad or depressed, 43% had low self-esteem, and 46% had behavioral dysfunction. While some children improved, a nearly equal number deteriorated, with no clear pattern of change. The only abuse-related variables associated with 5-year functioning were further contact with the abuser, which was significantly associated with depression and self-esteem, and sexual abuse prior to intake, which was related to an increased incidence of behavior problems. Older children showed more depression and lower self-esteem but less behavioral dysfunction. Poor family functioning at 5 years was associated with low self-esteem and behavior problems. Treatment had no effect on depression, self-esteem, or behavior. Multivariate analysis showed that depression and self-esteem at intake were prognostic indicators of 5-year outcome. CONCLUSION: Many sexually abused children have continuing problems with behavior, self-esteem, and depression. Family and abuse-related variables do not appear to be good predictors of outcome, although sexually abused children who are sad or depressed and have low self-esteem at intake are likely to have continuing problems in these areas.

Adolescent↗

PubMed1998

Effectiveness of functional communication training with and without extinction and punishment: a summary of 21 inpatient cases.

Functional communication training (FCT) is a frequently used treatment for reducing problem behavior exhibited by individuals with developmental disabilities. Once the operant function of problem behavior is identified by a functional analysis, the client is taught to emit an appropriate communicative response to obtain the reinforcer that is responsible for behavioral maintenance. Studies on FCT have typically used small numbers of participants, have reported primarily on clients for whom FCT was successful, and have varied with respect to their use of other treatment components. The main purposes of the present study were to evaluate the efficacy of FCT for treating severe problem behavior in a relatively large sample of individuals with mental retardation (N = 21) and to determine the contribution of extinction and punishment components to FCT treatment packages. FCT with extinction was effective in reducing problem behavior for the majority of clients and resulted in at least a 90% reduction in problem behavior in nearly half the applications. However, when demand or delay-to-reinforcement fading was added to FCT with extinction, treatment efficacy was reduced in about one half of the applications. FCT with punishment (both with and without fading) resulted in at least a 90% reduction in problem behavior for every case in which it was applied.

Adolescent↗

PubMed2000

The structure of self-reported aggression, drug use, and delinquent behaviors during early adolescence.

Examined the structure of self-report scales designed to assess the frequency of adolescent problem behaviors. Urban (n = 988) and rural (n = 1,895) middle school students completed the Problem Behavior Frequency Scale (Farrell, Danish, & Howard, 1992a) and measures of other relevant constructs. Confirmatory factor analyses supported a model that included specific factors related to aggression, drug use, and delinquent behaviors, and a higher order problem behavior factor. Findings did not support a distinction between physical and nonphysical aggression. Results were generally consistent across settings (i.e., urban vs. rural) and gender. Other relevant constructs, including peer pressure for drug use and attitudes favoring aggression, had both specific associations with relevant first-order factors and more general associations with the second-order factor. These findings support the construction of separate scales assessing specific domains of problem behaviors in studies of adolescents' problem behaviors.

Adolescent↗

PubMed2004

Increased behavioral morbidity in school-aged children with sleep-disordered breathing.

OBJECTIVE: To assess whether sleep-disordered breathing (SDB), ranging from primary snoring to obstructive sleep apnea (OSA), is associated with increased behavioral morbidity. METHODS: A cross-sectional study was conducted of school-aged children in an urban, community-based cohort, stratified for term or preterm (<37 weeks' gestation) birth status. A total of 829 children, 8 to 11 years old (50% female, 46% black, 46% former preterm birth) were recruited from a cohort study. All children had unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate for measurement of the apnea hypopnea index (number of obstructive apneas and hypopneas per hour). SDB was defined by either parent-reported habitual snoring or objectively measured OSA. Functional outcomes were assessed with 2 well-validated parent ratings of behavior problems: the Child Behavioral Checklist and the Conners Parent Rating Scale-Revised:Long. RESULTS: Forty (5%) children were classified as having OSA (median apnea hypopnea index: 7.1 per hour; interquartile range: 3.1-10.5), 122 (15%) had primary snoring without OSA, and the remaining 667 (80%) had neither snoring nor OSA. Children with SDB had significantly higher odds of elevated problem scores in the following domains: externalizing, hyperactive, emotional lability, oppositional, aggressive, internalizing, somatic complaints, and social problems. CONCLUSIONS: Children with relatively mild SDB, ranging from primary snoring to OSA, have a higher prevalence of problem behaviors, with the strongest, most consistent associations for externalizing, hyperactive-type behaviors.

Attention Deficit and Disruptive Behavior Disorder↗

PubMed1986

Mental health in Dutch children: (III). Behavioral-emotional problems reported by teachers of children aged 4-12.

Standardized teacher reports on children's behavioral-emotional problems can provide information on areas of children's functioning not readily accessible to other informants such as parents or clinicians. Once we accept the generally low agreement between different informants as inevitable, we may make use of the different types of information available from different sources. To do so we need base-line data from different informants that take account of key demographic variables such as gender, age and socio-economic status. In a previous report we provided such data for parent reported behavioral-emotional problems in children aged 4 through 16. In the present study we reported on the prevalence of a wide range of specific behavioral-emotional problems reported by teachers in a representative sample of 1,162 Dutch children aged 4 through 12; identified differences related to demographic variables and compared our data with those from other population based surveys. We used the Achenbach Teacher's Report Form (TRF) to collect our data because a comparison between different standardized teacher assessment instruments showed the TRF to be the most promising due to its solid psychometric background and its ready applicability. Our data supported the TRF's reliability and validity. For each of the 118 behavioral-emotional problems, the prevalence rates were presented graphically for both genders in two-year age groups. ANCOVAs were performed to assess the main effects and interaction of age and gender with SES as covariate for each problem item and total problem score. Of the demographic variables gender showed most numerous effects on problem items and showed the largest effect on total problem score. The main findings were: Boys obtained higher scores than girls. Many items on which boys scored higher are related to socially disapproved behavior. Boys obtained higher scores on concentration, attention and hyperactivity problems. Boys (especially the younger ones) scored higher on problems related to academic functioning. Teacher reports revealed larger gender differences than parent reports. Both parents and teachers scored boys higher on items predominantly associated with the externalizing syndrome. More boys than girls were attending education in special schools. Age showed no significant effect on total problem score, although older children were scored higher on a number of items associated with academic, somatic and social functioning and with emotions related to inner feelings.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗

PubMed2002

Concurrent reinforcement schedules: behavior change and maintenance without extinction.

We evaluated the effects of concurrent schedules of reinforcement on negatively reinforced problem behavior and task completion with 3 children with autism. Results indicated that problem behavior occurred at high levels and relatively few tasks were completed when problem behavior produced a break (from tasks) and task completion produced either no consequence or a break. By contrast, problem behavior was eliminated and tasks were completed when problem behavior produced a break and task completion produced a break with access to preferred activities. Treatment gains were maintained without the use of extinction when the response requirement was increased and the schedule of reinforcement was thinned.

Aggression↗

PubMedDate not supplied

Wisdom from the front lines: clinicians' descriptions of treating agitation in the nursing home, a pilot study.

The management of behavior problems is one of the most difficult challenges a clinician must face when treating patients with dementia. This article presents a qualitative analysis of the responses of 7 nursing home physicians and 1 nurse practitioner to open-ended questions regarding their experiences in treating behavior problems in dementia with an emphasis on nonpharmalogical methods. This study serves to highlight both the issues encountered by those commonly asked to treat behavior problems in the nursing home, and the thoughtfulness and insight developed by some clinicians to address the problems. Several themes emerged from clinicians' responses. Some of the clinicians developed algorithms for treating behavior problems. Some of the clinicians were frustrated with the expectation that behavior problems would be effectively treated pharmacologically. The treatment of behavior problems was described as complex and requiring more time than is allocated by reimbursement systems. They also expressed the need for multiple systemic changes in order to improve treatment, and provided many examples of inadequate resources, including reimbursement, staff, activities, staff training, and management issues needed to improve treatment of behavior problems in nursing home residents. On the positive side, they reported a high level of satisfaction when treating behavior nonpharmacologically. The clinicians felt that with appropriate systemic change many behavior problems can be either prevented or treated effectively by nonpharmacological means.

Aged↗

PubMed1989

Boys with hypospadias: a survey of behavioral difficulties.

Studied behavior problems and gender-role behavior of psychiatrically unselected boys (N = 69; ages 6-10 years) with mild or severe hypospadias, a genital anomaly. Parents completed standardized questionnaires in a postal survey. Subjects showed more behavior problems and lower social competency than nonclinical subjects but were better adjusted than a psychiatric-clinical control group. More severe anomalies were associated with increased behavior problems and poorer school performance. Boys with hypospadias had more cross-gender behavior which, however, was not associated with severity of the condition. Surgery-related hospitalizations were correlated with poorer school performance and increased cross-gender behavior. A history of hypospadias did not appear to have a lasting negative impact on the family.

Achievement↗

PubMed1994

Psychosocial, behavioral, and medical outcomes in children with epilepsy: a developmental risk factor model using longitudinal data.

OBJECTIVE: We studied factors predicting the risk of adverse long-term psychosocial, behavioral, and medical outcomes in children with epilepsy. METHODS: Children (N = 157, 4.5 to 13 years) were enrolled in a prospective longitudinal study when first seen. Potential subjects were excluded if they were moderately or severely mentally retarded, had motor or sensory handicaps interfering with testing, or did not speak either English or Spanish. MEASURES: To develop risk predictors, we collected information regarding the child's medical and seizure history, cognitive functioning, and behavior problems, and family functioning. Children and their families were followed for a minimum of 18 months, then underwent reassessment of medical status, parent's attitudes toward epilepsy, and the child's behavioral and cognitive functioning. Data were analyzed by confirmatory factor analysis to develop baseline factors (Sociocultural Risk, Seizure Risk, and Behavior Problems) and outcome factors (Medical/Seizure Problems, Parent's Negative Attitudes Toward Epilepsy, and Behavior Problems), followed by structural equation modeling to determine across-time causal effects. Eighty-eight subjects completed all baseline and outcome measures. RESULTS: Among significant across-time effects, Medical Outcome was predicted by Seizure Risk. An increased number of stressful life events predicted better Medical Outcome. Low acculturation increased Parent's Negative Attitudes and was associated with increased Behavior Problems at baseline. Behavior Problems were stable across time. It is interesting that IQ did not affect any of the outcomes, although its effect may have been mediated through other baseline measures. CONCLUSIONS: Seizure history was the best predictor of ongoing medical difficulties, whereas the most important causes of ongoing parental anxiety and negative attitudes toward epilepsy were sociocultural. Variation in medical or attitudinal outcomes was not influenced by either the child's IQ or reported behavioral problems. These findings suggest that to alter attitudes toward epilepsy, programs should be tailored to the sociocultural background of the family. Studies of quality of life of children with epilepsy should include appropriate sociocultural measures.

Acculturation↗

PubMed1993

Early initiation of sex and its lack of association with risk behaviors among adolescent African-Americans.

OBJECTIVE: High rates of adolescent homicide, pregnancy, substance abuse, and sexually transmitted diseases underscore the importance of interventions designed to reduce problem behaviors. However, the definition of "problem" behavior and the association with other activities may change between youth cultures. Therefore, greater attention to defining the "problem" behaviors to be targeted will permit more effective utilization of primary vs secondary intervention strategies and identification of high-risk individuals. DESIGN: Two studies of African-American adolescents regarding sexual intercourse, school truancy, substance abuse, and drug trafficking are presented. The first study involved 57 youths (10 to 14 years of age) from a pediatric primary health center and gathered data through pile-sorting. The second study of 300 youths (9 to 15 years of age) from six public housing sites used a questionnaire administered by a "talking" computer. Both studies assessed different self-reported behaviors, feelings about engaging in specific behaviors, and perceptions of friends' behaviors. RESULTS: While 40% of subjects reported having had sex, substantially smaller proportions reported school truancy (14%), illicit drug use (2% to 6%), or drug trafficking (6%). Analyses of reported behaviors, feelings, and perceived peer norms revealed that sex was consistently depicted as forming a different domain from other problem behaviors. CONCLUSIONS: Interventions that rely on primary prevention strategies for sexual intercourse and that identify sexually active youths as at risk for problem behaviors may not be appropriate for African-American adolescents growing up in resource-depleted urban areas.

Adolescent↗