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Results for “Behavioral problems”

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PubMed2004

The relationship between care-recipient behaviors and spousal caregiving stress.

PURPOSE: This study examines gender differences in spousal caregiver stress associated with care-recipient problem behaviors and helping behaviors. DESIGN AND METHODS: Using data from the National Long-Term Care Survey, we examined bivariate and multivariate relationships between the behaviors of care recipients and the stress experienced by their spouses. RESULTS: Gender differences in caregiver stress emerged with respect to problem behaviors and helping behaviors of the care recipient. Helping behaviors had a moderating effect on the relationship between care-recipient problem behaviors and stress for caregiving husbands, but not for caregiving wives. IMPLICATIONS: As practitioners attempt to reduce spousal caregiving distress, they should assess the extent to which care recipient's problem behaviors and efforts to be helpful contribute to caregiver stress.

Aged↗

PubMed2003

Use of the Pediatric Symptom Checklist in a low-income, Mexican American population.

OBJECTIVE: To evaluate the usefulness of the Pediatric Symptom Checklist (PSC) in identifying behavioral problems in low-income, Mexican American children. DESIGN: A cross-sectional study design was used to examine the PSC as a screening test, with the Child Behavior Checklist (CBCL) as the criterion standard. SETTING: The study was conducted at a health center in a diverse low-income community. Patients Eligible patients were children and adolescents, 4 to 16 years of age, who were seen for nonemergent, well-child care. Of 253 eligible children during a 9-month study period, 210 agreed to participate in the study. There was a 100% completion rate of the questionnaires. The average age of the children was 7.5 years, and 45% were female. Ninety-five percent of patients were of Hispanic descent (Mexican American); 86% of families spoke only Spanish. Socioeconomic status was low (more than three fourths of families earned <$20 000 annually). RESULTS: The CBCL Total scale determined that 27 (13%) of the children had clinical levels of behavioral problems. With a cutoff score of 24, the PSC screened 2 (1%) of the 210 children as positive for behavioral problems. Using the CBCL as the criterion standard, the PSC sensitivity was 7.4%, and the specificity was 100%. Receiver operator characteristic analysis determined that a PSC cutoff score of 12 most correctly classified children with and without behavioral problems (sensitivity, 0.74; specificity, 0.94). CONCLUSIONS: When using the PSC, a new cutoff score of 12 for clinical significance should be considered if screening low-income, Mexican American children for behavioral problems. Additional study is indicated to determine the causes of the PSC's apparently lower sensitivity in Mexican American populations.

Adolescent↗

PubMed1990

The social competence of children born prematurely: effects of medical complications and parent behaviors.

36-month-old, full-term children (n = 21) and low-birthweight (LBW) children of high (n = 25) and low (n = 23) medical risk status were observed in interactions with mothers in teaching and social context. Child compliance, self-directed behaviors, and problem behaviors were evaluated as well as associations among aspects of children's social competence, mothers' behaviors, and context factors. Degree of medical risk was associated with impairments in children's self-directed behavior and quality of response to maternal directives. Mothers of LBW children showed a smaller proportion of behaviors that provided choices compared to mothers of full-term children. Medical complications, children's cognitive status, and mothers' interactive behaviors were significantly associated with LBW children's social competence. Results of regression analyses suggested that mothers and LBW children influence each others' behavior in ways similar to mothers and full-term children in both teaching and social contexts.

Attention↗

PubMed1990

Who gets treated? Factors associated with referral in children with psychiatric disorders.

There is evidence from several industrialized countries that only a small proportion of children with psychiatric disorders receive specialist treatment. It is unclear, however, why some disturbed children are brought for treatment while others are not. To examine this issue in one community, children aged 7 through 11 were screened for behavioral problems using the Child Behavior Checklist (CBCL); 89 treated and 126 nontreated children, all of whom scored in the clinical range (above the 90th percentile) on the CBCL, were compared on measures of psychopathology, environmental factors and adaptive functioning. All the children were assessed using the Diagnostic Interview Schedule for Children. There was no difference between the groups in the proportions receiving a psychiatric diagnosis, or in the proportions with more than one psychiatric disorder. The nontreated disturbed children were as likely as the treated ones to have attention deficit disorders, anxiety, and oppositional disorders, and to be failing in school. The treated children had more cases of conduct disorder and depressive disorders, and were more likely to be poor, male and black. Teachers reported twice as many behavioral problems in treated as in untreated children, suggesting that adults' discomfort with children's behavior may have been a more potent precipitator of referral than the children's failure to perform well at school. The findings suggest that many nontreated children may be no less impaired than those who receive treatment, and that other factors than severity of psychopathology may dictate which disturbed children receive mental health services.

Child↗

PubMedDate not supplied

The ADAPT Program at Geriatrix, Inc.

Behavioral problems in elderly patients are stressful for families, long- term care staff and health care providers. The individual patient's quality of life can suffer, and other residents may become fearful when behavioral problems are not appropriately addressed. Management of other issues becomes more difficult. Treatment approaches exist for behavioral problems, but at Geriatrix we found them difficult to apply. In response, we developed and tested our own approach to the behavioral problems of Agitation, Depression, Anxiety, Pain, and Thinking, the ADAPT Program. (This is not to be confused with ADAPT, the Alzheimer's Disease Anti-inflammatory Prevention Trial). The mission of our program is to identify and stratify those behavioral problems that are treatable and then to apply established guidelines for the management of these problems. This goal is accomplished using the tools of (a) word association and (b) probability weighting that involve the entire care team as well as family members.

Journal Article↗

PubMed2006

Screening for behavioral health problems in primary care.

PURPOSE OF REVIEW: The epidemiology of behavioral health disorders in children and the current literature on the identification of these problems within primary care are reviewed. Suggestions are offered on how to implement screening within primary care settings. RECENT FINDINGS: The prevalence of behavioral health problems in children is approximately 12-27% yet the detection of these problems within the primary care setting is much lower. Although identification may be improving, underidentification and limited referral for services remain a significant problem. Few physicians use standardized instruments or DSM-IV criteria to identify children. Families, in addition, often do not disclose behavioral health concerns about their child to their physician. Multiple barriers exist for successful screening, including lack of training, limited time and poor reimbursement. Recent evidence suggests that a number of well validated instruments are now available for behavioral health screening within primary care. SUMMARY: Pediatric settings hold the potential to be an optimal environment to address behavioral health concerns due to the frequent contact and trusted relationship many families have with their pediatrician. There is new evidence that screening can be thoughtfully implemented and that system change around the detection of behavioral health problems is possible.

Adolescent↗

PubMedDate not supplied

Preinjury behavioral and emotional problems among pediatric burn patients.

Standardized behavior rating scales have been used in the routine care of children during medical visits because they provide an objective, norm-based index for the child's behavioral functioning. The purpose of this study was to examine behavior problems among children (aged 2.5-18 years) with burn injuries using the Behavioral Assessment System for Children, a multi-informant system of standardized rating scales that assesses clinical and adaptive behavior areas. Parents and youth (ages 8-18) completed the Behavioral Assessment System for Children with reference to the pediatric patient's behavioral functioning before hospital admission for a burn injury. In total, data were collected on 94 children. Results suggested that a substantial portion of the sample endorsed significantly elevated levels of behavioral difficulties across a broad range of problem behaviors. On the basis of parent report, preschoolers exhibited concerns related to hyperactivity, anxiety, aggression, and attention problems, whereas school-aged children were reported to have these same concerns as well as depression and conduct problems. Twenty percent of our adolescent sample (ages 12-18 years) were described to be experiencing even more internalizing and externalizing behavior problems relative to the two groups of their younger counterparts. Boys were found to contribute to the cause of their burn injury significantly more often than girls. The strengths, limitations, and clinical implications of our findings are discussed.

Adolescent↗

PubMed1994

Academic achievement and psychological adjustment in short children. The National Cooperative Growth Study.

Limited information is available on the educational and behavioral functioning of short children. Through 27 participating medical centers, we administered a battery of psychologic tests to 166 children referred for growth hormone (GH) treatment (5 to 16 years) who were below the third percentile for height (mean height = -2.7 SD). The sample consisted of 86 children with isolated growth-hormone deficiency (GHD) and 80 children with idiopathic short stature (ISS). Despite average intelligence, absence of significant family dysfunction, and advantaged social background, a large number of children had academic underachievement. Both groups showed significant discrepancy (p < .01) between IQ and achievement scores in reading (6%), spelling (10%), and arithmetic (13%) and a higher-than-expected rate of behavior problems (GHD, 12%, p < .0001; ISS, 10%, p < .0001). Behavior problems included elevated rates of internalizing behavior (e.g., anxiety, somatic complaints) and externalizing behavior (e.g., impulsive, distractable, attention-seeking). Social competence was reduced in school-related activities for GHD patients (6%, p < .03). The high frequency of underachievement, behavior problems, and reduced social competency in these children suggests that short stature itself may predispose them to some of their difficulties. Alternately, parents of short, underachieving children may be more likely to seek help. In addition, some problems may be caused by factors related to specific diagnoses.

Adaptation, Psychological↗

PubMed1995

Management of dementia-related behavioral disturbances: a nonpharmacologic approach.

OBJECTIVE: To describe practical nonpharmacologic approaches to dementia-related behavioral problems for enhancement of the function and care of elderly patients with dementia. DESIGN: We reviewed the pertinent medical literature and summarized strategies and available resources for management of geriatric patients with dementia and behavior problems. RESULTS: For optimal care of older patients with dementia, key concepts of related behavior problems must be understood. Agitation and aggression, resisting help with care, wandering, incontinence, sleep disturbance, and emotional lability can become difficult management issues with such patients. In some patients, these disruptions can lead to overmedication and nursing home placement. Herein, practical nonpharmacologic measures for management of behavior problems that arise among community-dwelling and institutionalized elderly patients with dementia are discussed. Attention is directed to the medical, psychologic, environmental, and social factors that may contribute to unwanted behaviors. CONCLUSION: Nonpharmacologic approaches can help ameliorate behavioral problems and assist in the overall care of elderly patients with dementia.

Dementia↗

PubMed1990

School-based prevention of teen-age pregnancy and school dropout: process evaluation of the national replication of the Teen Outreach Program.

Examined a program designed to prevent adolescent pregnancy, school failure, and dropout using a process model of evaluation to assess with which groups of participants and under what conditions the program was most effective. Students in the Teen Outreach Program of the Association of Junior Leagues and matched comparison students in 35 schools nationwide participated. Sites that highly utilized a volunteer service component, and sites that primarily served older students reported lower levels of student problem behaviors at program exit, after controlling for problem behaviors at entry. These findings occurred only for program youths and not for comparison youths. The connection of volunteer service to reductions in adolescent problem behaviors is interpreted in terms of helper-therapy and empowerment theories. Limitations of the analytic strategy used in this study, as well as techniques for addressing the limitations, are also discussed.

Adolescent↗

PubMed2006

Research on day treatment programs for preschoolers with disruptive behavior disorders.

OBJECTIVE: This review examined the literature on psychosocial treatments for preschoolers with disruptive behavior disorders to delineate ways in which interventions developed in research settings can be used to enhance existing clinical preschool day treatment programs. METHODS: A PsycINFO search was performed by using the keywords "day treatment," "behavior problems," "disruptive behavior disorder," and "oppositional defiant disorder" to find articles published between 1974 and 2004 on randomized controlled trials of psychosocial interventions for preschoolers (ages two to five years). No randomized controlled trials of multimodal day treatment programs were found. Therefore, studies on multimodal day treatment were selected on the basis of whether they presented quantitative outcome data. RESULTS AND CONCLUSIONS: Little research was available on the effectiveness of day treatment programs, despite the programs' prevalence as a treatment modality for disruptive preschoolers. In contrast, many interventions in the disruptive behavior disorder research have not made their way into clinical practice. Preschool day treatment programs may be enhanced by improving access to care, emphasizing social problem-solving skills, and using strategies to engage families in treatment. Research studies on existing day treatment programs are needed to clarify the role of these programs in child psychiatry clinics and to shed light on optimal methods of service delivery.

Attention Deficit and Disruptive Behavior Disorder↗

PubMed1989

Mothers' attitudes and their children's behaviors in 3-year-olds born prematurely and at term.

A sample of 94 mothers and their 3-year-old children participated in a cross-sectional study to measure maternal overprotective attitudes and children's behavior problems. Mothers in the full-term group (n = 47) were matched to mothers in the preterm group (n = 47) on maternal age, maternal education, and marital status. The groups were balanced for the child's gender, birth order, and mother's nationality. The subjects answered the Mother-Child Relationship Evaluation (MCRE) to measure maternal attitudes and the Behavior Screening Questionnaire (BSQ) to measure behavior problems in preschoolers. Overall, children born prematurely have the same incidence of behavior problems as children born full-term. However, the subgroup of preterms who had respiratory distress syndrome (RDS) had a higher incidence of behavior problems. Conversely, the results suggest that mothers of children born prematurely without RDS have more overprotective attitudes towards their children. Maternal overprotection is minimally associated with behavior problems.

Attitude↗

PubMedDate not supplied

Parental reactions to children's negative emotions: longitudinal relations to quality of children's social functioning.

Relations between self-reported parental reactions to children's negative emotions (PNRs) and children's socially appropriate/problem behavior and negative emotionality were examined longitudinally. Evidence was consistent with the conclusion that relations between children's externalizing (but not internalizing) emotion and parental punitive reactions to children's negative emotions are bidirectional. Reports of PNRs generally were correlated with low quality of social functioning. In structural models, mother-reported problem behavior at ages 10-12 was at least marginally predicted from mother-reported problem behavior, children's regulation, and parental punitive or distress reactions. Moreover, parental distress and punitive reactions at ages 6-8 predicted reports of children's regulation at ages 8-10, and regulation predicted parental punitive reactions at ages 10-12. Father reports of problem behavior at ages 10-12 were predicted by earlier problem behavior and parental distress or punitive reactions; some of the relations between regulation and parental reactions were similar to those in the models for mother-reported problem behavior. Parental perceptions of their reactions were substantially correlated over 6 years. Some nonsupportive reactions declined in the early to mid-school years, but all increased into late childhood/early adolescence.

Age Factors↗

PubMed1987

A comparison of the relative efficacy of self-control therapy and a behavioral problem-solving therapy for depression in children.

Twenty-nine children 9 to 12 years old who were identified as moderately to severely depressed using the Children's Depression Inventory were randomly assigned to either a self-control, behavioral problem-solving, or waiting list condition. The self-control treatment focused on teaching children self-management skills. The behavioral problem-solving therapy consisted of education, self-monitoring of pleasant events, and group problem solving directed toward improving social behavior. Subjects were assessed pre- and posttreatment and at 8-week follow-up with multiple assessment procedures and from multiple perspectives. At posttreatment, subjects in both active treatments reported significant improvement on self-report and interview measures of depression while subjects in the waiting list condition reported minimal change. Results were maintained at follow-up. The general success of the experimental treatments was discussed and recommendations for further treatment components were provided.

Behavior Therapy↗

PubMed1991

Psychosocial correlates of severe temper tantrums.

Temper tantrums are common and distressing, but little epidemiological information is available about them. Attempts to identify psychosocial correlates of tantrums have used small samples and have not controlled for multiple concurrent behavior problems. We analyzed interviews from 502 English mothers of 3-year-olds. Tantrums were considered present if mothers reported tantrums three or more times a day or lasting 15 minutes or longer. Behavior problems were assessed using the Behavior Screening Questionnaire. Tantrums were reported in 6.8% of children, of whom 52% had multiple behavior problems. Factors independently associated with tantrums included maternal depression and irritability, low education, and use of corporal punishment, manual social class, marital stress, child care provided exclusively by the mother, and poor child health. Tantrums were not associated (at p less than 0.01) with gender, maternal employment, low social support, or single parenthood. Severe tantrums may indicate the presence of multiple behavior problems and psychosocial stressors.

Child Behavior Disorders↗

PubMed2004

A study of genetic and environmental influences on maternal and paternal CBCL syndrome scores in a large sample of 3-year-old Dutch twins.

BACKGROUND: There is increasing evidence that behavioral problems are common in very young children, yet little is known about the etiology of individual differences in these problems. It is unclear to what degree environmental and genetic factors influence the development of early child psychopathology. In this paper, we focus on the following issues. Firstly, to what degree do genetic and environmental factors influence variation in behavioral problems? Secondly, to what degree are these underlying etiological factors moderated by sex and informant? We investigate these issues by analyzing Child Behavior Checklist (CBCL) data on 9689 3-year-old twin pairs. METHODS: Rater Bias and Psychometric Models were fitted to CBCL/2-3 data obtained from mothers and fathers to determine the genetic and environmental contributions to the five CBCL syndromes:aggressive, oppositional, overactive, withdrawn, and anxious/depressed behavior. RESULTS: Parental ratings are influenced by aspects of the child's behavior that are experienced in the same way by both parents and by aspects of the child's behavior that are experienced uniquely by each parent. There is evidence for high genetic contributions to all CBCL syndromes. Shared and non-shared environmental influences play significant roles as well. One exception is overactive behavior, which is influenced by genetic and non-shared environmental influences only. CONCLUSIONS: Variation in behavior problems in the very young shows high heritability. Individual raters offer unique perspectives that can have an impact on estimates of problem behavior and genetic architecture. Therefore, multi-informant approaches in the assessment of the very young will be useful to clinicians and researchers alike.

Adult↗

PubMed1999

Relationship between childhood behavioral disturbance and later schizophrenia in the New York High-Risk Project.

OBJECTIVE: An association between childhood behavioral disturbance and adulthood schizophrenia has been seen previously in retrospective or follow-back studies and in prospective studies. The authors examined the relationship between childhood behavioral problems and adulthood schizophrenia-related psychoses. Because a high rate of childhood behavioral problems is known to be associated with adult substance abuse, these analyses controlled for substance abuse. METHOD: The subjects of this investigation (N = 185) were offspring of parents with schizophrenia or affective disorder and of normal parents from the New York High-Risk Project (sample A). Data on childhood behavioral problems were obtained in a parent interview at initial assessment in 1971-1972. Adulthood outcomes (schizophrenia-related psychoses, affective disorders, anxiety disorders, substance abuse) were based on lifetime axis I diagnoses according to the Research Diagnostic Criteria. RESULTS: Substance abuse had a significant interaction with the clinical outcome groups. In subjects without substance abuse, those with schizophrenia-related psychoses had exhibited significantly more behavioral problems as children than had adult offspring with affective or anxiety disorder or with substance abuse only or no disorder. CONCLUSIONS: These results support the view that schizophrenia-related psychoses can be followed back to early behavioral disturbances. The confounding effects of substance abuse should be statistically controlled in studies of longitudinal associations between childhood behavioral disturbance and axis I outcomes.

Adult↗

PubMed1999

Lifetime low-level exposure to environmental lead and children's emotional and behavioral development at ages 11-13 years. The Port Pirie Cohort Study.

The Port Pirie Cohort Study is the first study to monitor prospectively the association between lifetime blood lead exposure and the prevalence of emotional and behavioral problems experienced by children. Lead exposure data along with ratings on the Child Behavior Checklist were obtained for 322 11-13-year-old children from the lead smelting community of Port Pirie, Australia. Mean total behavior problem score (95% confidence interval (CI)) for boys whose lifetime average blood lead concentration was above 15 microg/dl was 28.7 (24.6-32.8) compared with 21.1 (17.5-24.8) in boys with lower exposure levels. The corresponding mean scores (95% CI) for girls were 29.7 (25.3-34.2) and 18.0 (14.7-21.3). After controlling for a number of confounding variables, including the quality of the child's HOME environment (assessed by Home Observation for Measurement of the Environment), maternal psychopathology, and the child's IQ, regression modeling predicted that for a hypothetical increase in lifetime blood lead exposure from 10 to 30 microg/dl, the externalizing behavior problem score would increase by 3.5 in boys (95% CI 1.6-5.4), and by 1.8 (95% CI -0.1 to 11.1) in girls. Internalizing behavior problem scores were predicted to rise by 2.1 (95% CI 0.0-4.2) in girls but by only 0.8 (95% CI -0.9 to 2.4) in boys.

Adolescent↗