Conduct Problems and Level of Social Competence in Head Start Children: Prevalence, Pervasiveness, and Associated Risk Factors

The purpose of the current project was to determine the prevalence of conduct problems, low social competence, and associated risk factors in a sample of 4-year-old low-income children (N = 426) from 64 Head Start classrooms in the Seattle area. Conduct problems and social competence were assessed based on a combination of teacher reports, parent reports, and independent observations of children interacting with peers in the classroom and with parents at home. We examined the relative contribution of a variety of risk factors, including maternal history and socioeconomic background, current levels of stress and social support, mothers' emotional state, and parenting competence in relation to pervasive (i.e., at home and school) and nonpervasive conduct problems and low social competence. Findings indicated similar risk factors for conduct problems and for low social competence, with an ordered increase in the number of risk factors from normal to nonpervasive to pervasive groups. Harshness of parenting style (i.e., slapping, hitting, yelling) significantly distinguished between the three groups for low social competence and conduct problems. Positive affect, praise, and physical warmth from mothers were positively related to social competence but unrelated to conduct problems.     

Conduct Disorder in Girls: A Review of the Literature

The study of Conduct Disorder (CD) has primarily been limited to boys. The lack of research resulted from a premise that CD in girls was rare. However, CD in girls is a relatively common psychiatric diagnosis, and appears to be associated with several serious outcomes, such as Antisocial Personality Disorder and early pregnancy. Understanding gender differences in the course and severity of CD may lead to important information about etiology. Empirical studies on precursors, developmental course, risk factors and treatment for CD in girls are reviewed, while highlighting similarities and differences between girls and boys. Generally, CD symptoms in girls are stable. Precursors to CD in girls probably include Oppositional Defiant Disorder and temperamental factors, but also may include certain negative cognitions. What distinguishes CD in girls is the high risk they have to develop comorbid conditions, especially internalizing disorders. Risk factors for CD in girls partly overlap with those known for boys, but some factors appear to be highly salient for girls. Finally, there may be some significant effects of gender on treatment efficacy. Implications of these findings for future etiologic research are discussed.     

Decoupling the Relation Between Risk Factors for Conduct Problems and the Receipt of Intervention Services: Participation Across Multiple Components of a Prevention Program

This study examined whether the link between risk factors for conduct problems and low rates of participation in mental health treatment could be decoupled through the provision of integrated prevention services in multiple easily-accessible contexts. It included 445 families of first-grade children (55% minority), living in four diverse communities, and selected for early signs of conduct problems. Results indicated that, under the right circumstances, these children and families could be enticed to participate at high rates in school-based services, therapeutic groups, and home visits. Because different sets of risk factors were related to different profiles of participation across the components of the prevention program, findings highlight the need to offer services in multiple contexts to reach all children and families who might benefit from them. Ellen Pinderhughes's and Karen Bierman's colleagues in the Conduct Problems Prevention Research Group are, in alphabetical order, John D. Coie, Duke University; Kenneth A. Dodge, Duke University; E. Michael Foster, University of North Carolina; Mark T. Greenberg, Pennsylvania State University; John E. Lochman, University of Alabama; and Robert J. McMahon, University of Washington.     

The Comorbidity of Conduct Problems and Depression in Childhood and Adolescence

An extensive body of research documents the high prevalence of comorbidity among child and adolescent disorders in general and between conduct problems and depression in particular. These problems co-occur at significantly higher rates than would be expected by chance and their comorbidity may have significant implications for nosology, treatment, and prognosis. Four main hypotheses have been put forth to account for these high rates of comorbidity. First, comorbidity may be a result of shortcomings associated with referral or informant biases. Second, comorbidity may be an artifact of overlapping definitional criteria. Third, one disorder may cause the other disorder by influencing the developmental trajectory and placing an individual at increased risk for further difficulties. Finally, comorbidity between two disorders may be explained by shared underlying causal or risk factors. The purpose of this review is to explore these possibilities, concentrating primarily on the common risk factors of parent psychopathology, emotion regulation, and cognitive biases that may underlie the co-occurrence of these two disorders. Based on our review, we propose a model for the development of comorbidity between these two disorders.     

Significance of Childhood Conduct Problems to Later Development of Conduct Disorder Among Children With ADHD: A Prospective Follow-Up Study

This study investigates whether low to moderate levels of childhood oppositional defiant disorder (ODD) and conduct disorder (CD) behaviors contribute to the development of clinically diagnosed CD in adolescence, in children with attention deficit hyperactivity disorder (ADHD). Participants were 207 White boys (ages 6-12) with ADHD free of conduct disorder diagnoses. Parent and teacher ratings were obtained. Participants were assessed at mean age 18 by clinicians blind to childhood status. A non-ADHD group (recruited in adolescence) was also studied. ODD behavior ratings did not predict CD in adolescence, whereas CD behavior ratings did. No single ODD or CD behavior predicted adolescent outcome. ADHD probands with very low ratings (Not at all, Just a little) by parents and teachers on all CD behaviors were still at significantly increased risk for CD in adolescence, compared to non-ADHD controls. The same relationships were found between childhood ODD and CD behaviors, and antisocial personality disorder in adulthood (mean age, 25). We conclude that childhood ADHD is a developmental precursor of later antisocial disorder, even in the absence of comorbid ODD or CD in childhood. However, low levels of CD-type problems are not innocuous, because they predict later CD among children with ADHD without comorbid CD.     

Predicting the Stability of Conduct Problems in Children with and Without Callous-Unemotional Traits

We tested predictors of persistence in conduct problems for children with and without callous-unemotional (CU) traits. Participants were 79 children of an original 98 children recruited from a community-wide screening to oversample children with conduct problems and to ensure equal numbers of children high and low on CU traits. The sample was reassessed at four yearly intervals and the 79 children (81%) were those with data at all four assessments. Children within each conduct problem group were divided into those with more and less stable patterns of conduct problems based on structured interviews with parent and child. Stability in conduct problems for children without CU traits was more strongly related to level of impulsivity and socioeconomic status, whereas children high on CU traits showed more stable conduct problems if they experienced higher rates of life stressors.     

Treatment of Comorbid Conduct Problems and Depression in Youth: A Pilot Study

The purpose of this study was to pilot a cognitive behavioral treatment protocol for adolescents with co-occurring conduct problems and depression. A non-concurrent multiple baseline design was used to assess the effectiveness of the intervention. A sample of five adolescents, aged 11 to 14 years, participated; all five families completed the protocol. Results indicated that symptoms of oppositionality were significantly reduced. Moreover, maternal ratings suggested significant improvements in emotion regulation in their children and cohesion in the family. However, symptoms of depression showed little improvement. Results of this study have implications for improving treatment outcomes for youth with these comorbid conditions and may lead to increased conceptual understanding of these comorbid problems.     

Allergies and Anxiety in Children and Adolescents: A Review of the Literature

  There is an increasing prevalence of anxiety disorders and allergic conditions in children and adolescents, with previous research showing that these illnesses are often comorbid. Knowledge of the association between anxiety and allergies in children and adolescents is important because these comorbid disorders may negatively impact functioning and development. This research is necessary for identification of at risk children and to develop intervention and prevention programs. A review of studies examining comorbid anxiety and allergies in children and adolescents demonstrated a consistent association between these disorders despite differences in methodology. Several methodological limitations are presented, followed by a discussion of theories which may explain the association between these conditions. Implications of this work and suggestions for future research are provided.     

Taxonomic Examination of ADHD and Conduct Problem Comorbidity in Elementary School Children Using Cluster Analyses

Cluster analysis was used to investigate the classification of comorbid Attention Deficit Hyperactivity Disorder (ADHD) +Conduct Problems (CP). Teachers rated 1394 elementary school children on symptoms of inattention, hyperactivity/impulsivity, opposition, and conduct problems using the ADS-IV behavior-rating scale. Results suggested that a seven-cluster solution, including two distinct comorbid clusters, was the most appropriate method of classifying children according to behavioral symptoms. A one-way MANOVA showed that overall cluster profiles differed significantly from each other, whereas one-way ANOVAs indicated that clusters differed on age and symptom scores. Chi-square analyses indicated that clusters differed on gender. Post hoc analyses and effect sizes calculations revealed that the comorbid clusters differed from each other and from their single-disorder counterparts on some variables, but not on all. These results provide support for an additive conceptualisation of ADHD +CP.     

Preventative Behavioral Parent Training: A Preliminary Investigation of Strategies for Preventing At-Risk Children From Developing Later Conduct Problems

Children exhibiting conduct problems comprise the largest source of referrals to children's mental health services. The treatment for conduct problems that possesses the greatest amount of empirical support is behavioral parent training. Unfortunately, a cogent approach to the identification of risk factors and prevention of chronic conduct problem display has not been developed. This project was an initial longitudinal assessment examining the merits of preventative behavioral parent training as a primary prevention strategy for at-risk children. Results demonstrated that prevention participants were engaging in normative rates of disruptive behaviors at 6-month follow-up, whereas comparison children showed a behavioral decline over time.     

Using Cognitive Behavior Therapy in Clinical Work With African American Children and Adolescents: A Review of the Literature

A comprehensive review of the literature on clinical work with African American youth with cognitive behavior therapy (CBT) is presented. The strengths and limitations of CBT in relation to this population are outlined. Although CBT shows promise in helping, research on the efficacy and effectiveness of CBT in this group is lacking. Se presenta una reseña exhaustiva de la literatura sobre trabajo clínico con jóvenes Afroamericanos usando terapia cognitiva conductual (TCC). Se perfilan los puntos fuertes y las limitaciones de la TCC en relación a esta población. A pesar de que la TCC muestra signos prometedores para servir de ayuda, no hay suficiente investigación sobre la eficacia y efectividad de la TCC en este grupo.     

Behavioral Family Interventions for Improving Child-rearing: A Review of the Literature for Clinicians and Policy Makers

This paper reviews evidence that behavioral family interventions are effective at improving child-rearing in distressed families and families with children exhibiting disruptive behavior. Essential therapeutic strategies offered within a collaborative therapeutic process are identified. Exemplary materials for parents and clinicians are identified. Differences between behavioral family interventions and two popular press parenting approaches are highlighted, including the lack of empirical support for these widely used programs and the advice they offer which runs counter to behavioral approaches. Recommendations are offered for combining behavioral family interventions with other empirically supported approaches, promoting more widespread use of empirically supported treatments, such as behavioral family interventions, and the need for a public health perspective on family functioning, involving collaboration among clinicians, policy makers, and researchers.     

Families of Children With Attention-Deficit/Hyperactivity Disorder: Review and Recommendations for Future Research

This review integrates and critically evaluates what is known about family characteristics associated with childhood Attention-Deficit/Hyperactivity Disorder (ADHD). Evidence suggests that the presence of ADHD in children is associated to varying degrees with disturbances in family and marital functioning, disrupted parent–child relationships, specific patterns of parental cognitions about child behavior and reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology, particularly when ADHD is comorbid with conduct problems. However, the review reveals that little is known about the developmental mechanisms that underlie these associations, or the pathways through which child and family characteristics transact to exert their influences over time. In addition, the influence of factors such as gender, culture, and ADHD subtype on the association between ADHD and family factors remains largely unknown. We conclude with recommendations regarding the necessity for research that will inform a developmental psychopathology perspective of ADHD.     

Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

The purpose of this study was to examine whether callous–unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, M_age = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.     

Children and Adolescents with Medically Unexplained Symptoms: A Systematic Review of the Literature

Abstract

Medically unexplained symptoms (MUS) in children and adolescents are confounding and concerning for patients, parents, and health care practitioners. Our goal was to review and summarize the literature for family therapists working with a diverse, challenging patient population coping with MUS. A search of multiple databases from 1994 to 2018 was conducted using MUS and related terms. The literature was then organized into subcategories based on its relevance to family therapists, particularly medical family therapists collaborating with primary care physicians. We conclude with a discussion about gaps in the literature and suggestions for clinical management.     

我国农村地区婴幼儿的喂养问题与对策

喂养不当是导致婴幼儿生长发育不良及营养障碍性疾病的主要原因。婴幼儿的喂养问题在我国农村地区尤为突出,主要表现在喂养方式、添加辅食和喂养行为等方面。文章重点围绕上述3个方面展开分析、提出对策,以期为政府决策、儿童保健人员及喂养者提供参考。     

Improving Our Understanding of Impaired Social Problem-Solving in Children and Adolescents with Conduct Problems: Implications for Cognitive Behavioral Therapy

Clinical Child and Family Psychology Review - In cognitive behavioral therapy (CBT) children and adolescents with conduct problems learn social problem-solving skills that enable them to behave in...     

Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.