The Role of Maternal Depression on Treatment Outcome for Children with Externalizing Behavior Problems

Studies have shown that, on average, Parent Management Training combined with cognitive-behavioral therapy decreases children’s externalizing behavior, but some children do not improve through treatment. The current study aimed to examine the role of maternal depression in understanding this variability in treatment outcome. Children with externalizing behavioral problems and their parents were recruited from combined Parent Management Training and Cognitive-Behavioral programs in “real-world” clinical settings. At pre- and post treatment, maternal depression and children’s externalizing behavior were assessed. Results showed that treatment was less effective for children of depressed mothers compared to non-depressed mothers and that improvements in maternal depression were associated with improvements in children’s externalizing behavior. These findings suggest that treatment programs for children with externalizing problems may be able to improve outcomes if maternal depression is a target of intervention.     

Trajectories of externalizing behavior from age 2 to age 9: relations with gender, temperament, ethnicity, parenting, and rater

Trajectories of children's externalizing behavior were examined using multilevel growth curve modeling of data from the NICHD Study of Early Child Care and Youth Development. According to ratings by both mothers and caregivers/teachers when children were 2, 3, 4, 7, and 9 years old, externalizing behavior declined with age. However, mothers rated children as higher in externalizing behavior than did caregivers and teachers. Higher levels of age 9 externalizing behavior were predicted by the following factors: child male gender (for caregiver/teacher reports only), infant difficult temperament (for children with harsh mothers only), harsher maternal attitude toward discipline, higher level of maternal depression (for maternal reports only), and lower level of maternal sensitivity (especially for boys). Caregivers and teachers reported higher levels of externalizing behavior in African American children than in European American children, increasingly so over time; mothers' ratings revealed the reverse. The declining slope of externalizing behavior was predicted by infant difficult temperament for mother reports only. Additional analyses suggested that the association between parenting and externalizing behavior was bidirectional.     

Examining Influences on Problem Recognition and Help-Seeking for Child Externalizing Behaviors Among African American Mothers

Childhood behavior problems are one of the most common clinical referrals. If left untreated, these behaviors can result in detrimental consequences to the child’s development (Wehmeier et al., 2010; Scholtens et al., 2012). Behavior parent training has been identified as first-line treatment for oppositional behavior; however, many racial minority families fail to enroll in behavior parent training. The current study examines maternal help-seeking for children displaying oppositional behavior in hopes to delineate variables that might influence parent training enrollment among African American families. Participants were 112 African American mothers who were provided child behavior vignettes and completed measures assessing factors related to problem recognition, parental attributions, child rearing values, mental health stigmatization, racial identity, and treatment utilization. Results found that when presented with a child displaying clinically significant externalizing child behaviors, slightly more than half of African American mothers recognized clinically significant child behavior problems. Mothers were more likely to engage in behavioral parent training if problematic behavior was recognized. Additionally, mothers’ attributions of child behavior, cultural values, and mental health stigmatization were influential to help seeking. This study supports the importance of considering cultural variables that impact problem recognition and subsequent treatment utilization among African American families.     

The Relation Between Maternal ADHD Symptoms &; Improvement in Child Behavior Following Brief Behavioral Parent Training is Mediated by Change in Negative Parenting

This study examined the extent to which maternal attention-deficit/hyperactivity disorder (ADHD) symptoms predict improvement in child behavior following brief behavioral parent training. Change in parenting was examined as a potential mediator of the negative relationship between maternal ADHD symptoms and improvement in child behavior. Seventy mothers of 6–10 year old children with ADHD underwent a comprehensive assessment of adult ADHD prior to participating in an abbreviated parent training program. Before and after treatment, parenting was assessed via maternal reports and observations and child disruptive behavior was measured via maternal report. Controlling for pre-treatment levels, maternal ADHD symptomatology predicted post-treatment child disruptive behavior problems. The relation between maternal ADHD symptomatology and improvement in child behavior was mediated by change in observed maternal negative parenting. This study replicated findings linking maternal ADHD symptoms with attenuated child improvement following parent training, and is the first to demonstrate that negative parenting at least partially explains this relationship. Innovative approaches combining evidence-based treatment for adult ADHD with parent training may therefore be necessary for families in which both the mother and child have ADHD. Larger-scale studies using a full evidence-based parent training program are needed to replicate these findings.     

Effects of Maternal Depression Symptoms and Alcohol Use Problems on Child Internalizing and Externalizing Behavior Problems

Empirical evidence suggests maternal behavioral health problems are significant predictors of child behavioral health difficulties, but it is unclear of the specific relation of maternal alcohol use problems and depression symptoms with child internalizing and externalizing behavior problems. The purpose of the study is to examine the impact of maternal depression symptoms and alcohol use problems on children’s internalizing and externalizing behavior problems over a period of 5 years. Implications for intervention may differ depending on which type of maternal behavioral health concerns predicts which child behavior problem. A total of 1874 families eligible for Early Head Start participated. Maternal depression symptoms and alcohol use problems were assessed when children were in preschool, and internalizing and externalizing behavior problems were assessed when children were in fifth grade. Clinical internalizing behavior problems was best predicted by maternal depression symptoms, whereas clinical externalizing behavior problems was best predicted by maternal alcohol use problems. Children were almost twice as likely to have clinical internalizing behavior problems when mothers exhibited very elevated depression symptoms compared to when mothers displayed minimal symptoms. A similar relation was found with maternal alcohol use problems and clinical externalizing behavior problems. Our findings highlight the importance of understanding and treating various kinds of behavioral health concerns in mothers of young children.     

The Severely Impaired Do Profit Most: Differential Effectiveness of a Parent Management Training for Children with Externalizing Behavior Problems in a Natural Setting

We investigated the differential effectiveness of a parent management training program for children with externalizing problem behavior. The parent management training was tested using a within-subject control group design. 270 families with children aged 3–10 years were included and assessments were made at 3 months before treatment, immediately before treatment, immediately after treatment, and at 12 months follow-up. We analyzed data using growth mixture modeling. For attention problems, we obtained a two-subgroup solution. One subgroup started with high initial values indicating more severe impairment, and the other subgroup had low initial values. The more impaired group showed stronger treatment effects. For disruptive behavior problems, our analyses revealed a three-subgroup solution. Two subgroups exhibited high initial levels of disruptive behavior problems and the third subgroup had low initial levels. One of the more impaired groups exhibited a strong decrease in problem behavior during treatment, while the other two groups only showed moderate decreases. For attention problems and disruptive behavior problems, some of the most impaired children gained the most from parent training.     

A conceptual model for the development of externalizing behavior problems among kindergarten children of alcoholic families: role of parenting and children's self-regulation

The purpose of this study was to test a conceptual model predicting children's externalizing behavior problems in kindergarten in a sample of children with alcoholic (n = 130) and nonalcoholic (n = 97) parents. The model examined the role of parents' alcohol diagnoses, depression, and antisocial behavior at 12-18 months of child age in predicting parental warmth/sensitivity at 2 years of child age. Parental warmth/sensitivity at 2 years was hypothesized to predict children's self-regulation at 3 years (effortful control and internalization of rules), which in turn was expected to predict externalizing behavior problems in kindergarten. Structural equation modeling was largely supportive of this conceptual model. Fathers' alcohol diagnosis at 12-18 months was associated with lower maternal and paternal warmth/sensitivity at 2 years. Lower maternal warmth/sensitivity was longitudinally predictive of lower child self-regulation at 3 years, which in turn was longitudinally predictive of higher externalizing behavior problems in kindergarten, after controlling for prior behavior problems. There was a direct association between parents' depression and children's externalizing behavior problems. Results indicate that one pathway to higher externalizing behavior problems among children of alcoholics may be via parenting and self-regulation in the toddler to preschool years.     

Filial therapy: effects on two children's behavior and mothers' stress.

Due to patients' continual and natural contact with their children, as well as shortages of professionals, parents are increasingly being asked to play a significant role in treatment for the children's emotional and behavior problems. Filial therapy is a treatment that involves parents by teaching parents to conduct child-centered play therapy sessions with their children. The current study sought to examine filial therapy effectiveness by measuring changes in children's behavior and parental stress in parenting. Mothers of two preschool children were administered the Behavior Assessment for Children and the Parenting Stress Index prior to, following completion of, and 2 mo. after participating in a 10-wk. filial therapy training program. Results suggest significant decreases in externalizing behaviors and decreased parenting stress for one parent of the two children. Informal parental reports of changes suggest that parents saw improved relationships with their children, their own confidence increased, generalization of skills, and improvements with regard to behavior problems.     

Understanding treatment effectiveness for aggressive youth: the importance of regulation in mother-child interactions

Reviews summarizing hundreds of studies cite parent management training (PMT) and cognitive-behavior therapy (CBT) as some of the most effective interventions for aggressive youth. However, studies continue to report variability in outcomes, and researchers have yet to understand why certain interventions only produce behavior change in some children. Using a clinical sample of 57 children (53 boys, 4 girls; mean age = 9.33, standard deviation = 1.16) and their mothers enrolled in a combined PMT/CBT program, the current study examined the relation between changes in real-time mother-child interactions, and children's externalizing outcomes from pre- to posttreatment. Results showed that dyads who were regulated in their interactions over time reported greater reductions in externalizing symptoms from pre- to posttreatment as compared with dysregulated dyads. Changes in mean levels of affective content (e.g., negativity) were not associated with externalizing outcomes. Findings suggest that dyadic regulation may be an important process associated with treatment success for aggressive youth.     

Examining the trajectory of parent emotion talk in mothers of toddlers: A predominantly Latine sample

Supportive parent emotion socialization has been associated with greater child emotion understanding and expression and lower levels of externalizing behavior problems, with limited understanding on parent emotion socialization in toddlerhood. The current study examined the developmental trajectory of emotion socialization via emotion talk in mothers of toddlers from a predominantly Latine sample. Participants were 101 mother-toddler dyads assessed over three time points from ages 12–25 months. Overall, maternal emotion talk remained relatively stable over time, although there was a significant decrease between the first and second assessments before returning to initial rates at the third assessment. Maternal emotion talk did not predict child externalizing behavior over time. Interestingly, however, greater toddler externalizing behavior problems was associated with an increase in maternal emotion talk over time. These findings suggest maternal emotion talk is relatively stable for parents of children who are low on externalizing behaviors and may fluctuate (i.e., slowly increase) for mothers of children who are high in externalizing behaviors. Understanding these mechanisms further could help inform how we implement and personalize parenting interventions.     

A Teacher-Consultation Approach to Social Skills Training for Pre-Kindergarten Children: Treatment Model and Short-Term Outcome Effects

This study evaluated the post-treatment outcome effects of a classroom-based social skills program for pre-kindergarten children, using a teacher-consultation model. The pre-K RECAP (Reaching Educators, Children, and Parents) program is a semi-structured, cognitive-behavioral skills training program that provides teachers with in-classroom consultation on program implementation and classroom-wide behavior management. Data on children's social skills and behavior problems were collected from parents and teachers at pre- and post-treatment, for 149 children aged 4–5 years (of whom 56% were girls). Significant treatment effects were found for teacher but not parent reports, with treatment group children improving significantly more than comparison group children in their teacher-rated social skills and internalizing and externalizing problems. These results provide some preliminary support for the efficacy of the program on children's social skills and behavior problems, and for a teacher-consultation model for training teachers to implement school-based mental health programs.     

母亲抑郁和惩罚对儿童早期问题行为的影响及父亲的保护作用

儿童早期是母亲消极情绪和行为的易感期,母亲抑郁和消极的教养行为可能导致儿童早期多方面的发展问题,而父亲的积极教养则可能对孩子的健康发展起到保护作用。本研究以184名学前儿童的父亲和母亲为被试,考察母亲抑郁情绪和惩罚行为对儿童问题行为的影响及作用机制,以及父亲积极鼓励在其中的调节作用。结果发现:(1)母亲抑郁显著预测儿童的内向问题行为,母亲惩罚显著预测内向和外向问题行为;(2)母亲抑郁完全通过其惩罚行为影响儿童的外向问题行为,部分通过惩罚影响儿童的内向问题行为;(3)父亲积极鼓励显著调节母亲抑郁对外向问题行为的影响,边缘显著调节母亲抑郁对内向问题行为的影响;父亲积极鼓励对母亲惩罚与内、外向问题行为之间的关系的调节不显著,表明积极的父亲鼓励可以缓冲母亲抑郁对儿童问题行为的影响。     

Examining Maternal Elaborative Reminiscing as a Protective Factor in the Intergenerational Transmission of Psychopathology

Most research examining the impact of early parental depression on the developing child has focused on the nature of parenting practices observed in depressed adults. Maternal elaborative reminiscing, or the extent to which mothers elaboratively discuss past shared experiences with their children, has a considerable influence on children’s emotional and social development and is understudied within the context of maternal depression. The current study is the first to examine whether maternal elaborative reminiscing in middle childhood mediates the association between exposure to maternal depressive symptoms in infancy and later internalizing and externalizing problems. The study included 206 mother–child dyads recruited from the community who participated in a prospective longitudinal study. Maternal depressive symptoms were assessed when offspring were 6-months old. At 5-years old, dyads were observed during a free play task to measure sensitive and harsh-intrusive parenting and during a reminiscing task to measure maternal elaboration. Teacher-reported internalizing and externalizing problems were collected at age 7. A saturated path model revealed that maternal elaborative reminiscing, but not sensitive or harsh-intrusive parenting, fully mediated the association between maternal depression in infancy and externalizing, but not internalizing, problems. Reduced maternal elaboration during parent–child reminiscing constitutes one way in which risk from early maternal depression is associated with later externalizing problems.

     

Behavior Problems in Young Children With or At Risk for Developmental Delay

We examined the prevalence of behavior problems and their relationship to child, parent, and family factors in 76 children with or at risk for developmental delay. Parents reported that 42% of the children had behavior problems. Child Behavior Checklist (CBC) scores revealed that 25% of the sample scored above the borderline cutoff. Although the total, externalizing, and internalizing mean CBC scores did not differ from the normative group (same-aged peers without developmental delay), each of the syndrome subscales was significantly higher in the study group. The Reiss Scales for Children's Dual Diagnosis revealed that, as compared to older children (4 years) with developmental delay, the study sample scored significantly lower on the total score and 8 of the 10 subscales. Increased CBC total scores were significantly related to dependency and management of the child, birth weight, gestational length, paternal illness, maternal depression, perceived personal burden of care, maternal escape-avoidance coping strategy, family disharmony, and financial stress. CBC total scores were significantly negatively correlated with being of a multiple birth, paternal education, maternal employment, two-parent family, family social support, and family income. Multiple regression analyses revealed that an empirically-derived combination of child, parent, and family variables accounted for 31% of the variance in CBC total scores. Our findings suggest that 2-year old children with or at-risk for developmental delay may already be showing signs of increased risk of behavior problems relative to peers without developmental delay. We identified several child, parent, and family variables that may help to pinpoint children at increased riskxs for psychopathology.     

Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training

To scale up evidence-based treatment of conduct problems, parent management training, Oregon model (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groups with and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined group's behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.     

母亲负性情绪与儿童外化问题行为的关系：家庭嘈杂度的调节作用

摘 要 对251名学前儿童及母亲进行一年的追踪来考察母亲负性情绪与学前儿童外化问题之间的关系及这一关系是否受到家庭嘈杂度的影响。结果: (1) T1儿童外化问题能正向预测T2母亲负性情绪,而T1母亲负性情绪对T2儿童外化问题的预测不显著;(2)与低嘈杂家庭相比,高嘈杂家庭中儿童外化问题对母亲负性情绪的预测作用更强,且儿童外化问题也更为稳定。结论：母亲负性情绪与儿童外化问题的关系主要表现为儿童效应,且这一效应受到家庭环境的调节。     

Parent-Child Interaction Therapy for Children Born Premature: A Case Study and Illustration of Vagal Tone as a Physiological Measure of Treatment Outcome

Evidence-based psychosocial interventions for externalizing behavior problems in children born premature have not been reported in the literature. This single-case study describes Parent-Child Interaction Therapy (PCIT) with a 23-month-old child born at 29 weeks gestation weighing 1,020 grams, who presented with significant externalizing behavior problems. Treatment outcome was assessed using standard measures of maternal and child functioning and observational measures of the parent-child interaction, as well as a physiological measure of heart rate variability (i.e., vagal tone) used to assess parasympathetic control in the child. Maternal reports of child behavior problems and their own stress and depressive symptoms decreased after treatment. Behavioral observations demonstrated improved parenting practices and child compliance, and vagal tone showed comparable increases as well. Results suggest that PCIT is a promising psychosocial intervention for children born premature with externalizing behavior problems, and that vagal tone may be a useful measure of treatment outcome.     

Moderators of the Relationship Between Maternal Substance Abuse Symptoms and Preschool Children’s Behavioral Outcomes

While maternal substance use problems increase the likelihood of behavior problems in children, child outcomes are varied, leading to interest in understanding additional family factors that contribute to the development of behavior problems in children impacted by maternal substance abuse. The purpose of this study is to examine harsh parenting and family conflict as potential moderators of the relationship between symptoms of maternal substance use problems and child externalizing behavior problems. The non-clinical sample for this study included 250 low-income parents whose preschool age children were enrolled in Head Start programs in a Southern state. This study utilized data collected during two home visits, an average of 10 months apart, with data on family functioning and maternal symptoms of substance use problems collected at the first time point and child externalizing behavior collected at the second time point. Over one-third of the children (38.1 %) had clinically elevated externalizing behavior scores. We used regression analysis to examine whether harsh parenting or family conflict moderated the relationship between maternal substance use symptoms and child externalizing behavior. In this community sample, we found that in the absence of family risks related to harsh parenting and family conflict, maternal symptoms of substance use problems did not have a significant impact on child externalizing behavior in preschool children. However, when high levels of family conflict or harsh parenting were present, symptoms of maternal substance use problems increased the risk of externalizing behavior problems in children.     

Erratum to: Parental Anxiety and Child Symptomatology: An Examination of Additive and Interactive Effects of Parent Psychopathology

The current study examined relations between parent anxiety and child anxiety, depression, and externalizing symptoms. In addition, the study tested the additive and interactive effects of parent anxiety with parent depression and externalizing symptoms in relation to child symptoms. Forty-eight parents with anxiety disorders and 49 parents without any psychiatric disorder participated with one of their children (ages 6 to 14 years; 46.4% male; 75.8% Caucasian). Parent anxiety was related to both child anxiety and depression, but not child externalizing symptoms. Hierarchical regression analyses showed that only parent externalizing symptoms had additive effects, beyond parent anxiety symptoms, in relation to child anxiety symptoms. Further, parent anxiety symptoms moderated the relationship between parent and child externalizing symptoms, such that the strength of this relationship was reduced in the presence of high levels of parent anxiety symptoms. Results of this study illuminate the role of parent comorbidity in understanding relations between parent and child symptoms.     

Parental Anxiety and Child Symptomatology: An Examinzation of Additive and Interactive Effects of Parent Psychopathology

The current study examined relations between parent anxiety and child anxiety, depression, and externalizing symptoms. In addition, the study tested the additive and interactive effects of parent anxiety with parent depression and externalizing symptoms in relation to child symptoms. Forty-eight parents with anxiety disorders and 49 parents without any psychiatric disorder participated with one of their children (ages 6 to 14 years; 46.4% male; 75.8% Caucasian). Parent anxiety was related to both child anxiety and depression, but not child externalizing symptoms. Hierarchical regression analyses showed that only parent externalizing symptoms had additive effects, beyond parent anxiety symptoms, in relation to child anxiety symptoms. Further, parent anxiety symptoms moderated the relationship between parent and child externalizing symptoms, such that the strength of this relationship was reduced in the presence of high levels of parent anxiety symptoms. Results of this study illuminate the role of parent comorbidity in understanding relations between parent and child symptoms.