The Impact of Managing School-aged Children’s Diabetes: The Role of Child Behavior Problems and Parental Discipline Strategies

Models of diabetes management in children emphasize family relationships, particularly parent–child interactions. In adolescents, parental involvement in disease-specific management relates to better health and adherence. However, information about parental involvement in disease management for young children is limited and mixed. This study investigated behavior problems of school-aged children with Type 1 Diabetes Mellitus (T1DM) in association with parent discipline strategies and parents’ perceptions of (1) time spent managing diabetes and (2) the impact their child’s diabetes has on their discipline strategies. Parents of children ages 5–12 with T1DM completed standardized measures of child misbehavior, parent discipline strategies, and responded to questions regarding perceived time spent managing diabetes, and perceived impact of diabetes on ability to discipline. Results showed child mealtime misbehavior was common and associated with overreactive parental discipline. Further, overreactive discipline was also associated with reports of less time spent managing child’s illness. Child misbehavior was positively associated with parents’ perceived amount of time spent managing diabetes and with the impact of child diabetes on discipline. Findings suggest the importance of considering parent discipline strategies and child misbehavior when working with young children with diabetes.     

Effects of parent and child characteristics on participation and outcome of an individualized booster parent intervention for children with externalizing behaviour

In this study, we examined whether a booster parent training, offered after a cognitive behavioural child intervention, is effective in reduction of aggressive behaviour and changes in parenting. A second aim was to identify parent and child characteristics that influence parental participation. Children (73% boys, 40% immigrants, mean age = 10.1 (.53)) were randomly assigned to the child (n = 97 children) or child and parent intervention (n = 94 children) condition. Results of both intention-to-treat and completers only analyses indicated no extra effects of the parent intervention for the total group. Parents who participated (47%) did not differ from non-participants in demographic characteristics. However, mother's perceived level of child's aggression at the end of the child intervention was of significant meaning for the decision to participate in the parent intervention. Participation seemed to interrupt the development of more aggressive behaviour and less appropriate parenting skills for those children in highest need and resulted in increased maternal involvement.     

Socioeconomic Factors in Relation to Discrepancy in Parent versus Teacher Ratings of Child Behavior

Discrepancies between observers are common in studies of child behavior problems that rely on behavior ratings. Although modest concordance between informants is well-documented, little is known about characteristics that predict discrepancies. In 477 children aged 5 to 12 years, maternal age and indicators of socioeconomic status (SES; maternal education, family income) were evaluated in relation to score discrepancies between the Child Behavior Checklist and Teacher Report Form for Total, Externalizing and Internalizing Problems. Family income <?$35,000 was independently associated with discrepancies in which mothers rated more clinically significant child behavior problems than teachers for Total, Externalizing and Internalizing Problems [odds ratio (OR)?=?3.26, 95 % confidence interval (CI), 1.19–8.96, OR?=?2.76, 95 % CI 1.03–7.34 and OR?=?3.07, 95 % CI 1.30–7.26, respectively]. Maternal education was not associated with discrepancies, but younger mothers were less likely to rate child’s behavior in the clinical range for Externalizing Problems than teachers (OR per year of age?=?0.88, 95 % CI 0.81–0.96). These results suggest that studies that utilize only maternal or teacher report of child behavior may have misclassification of outcomes that is dependent on SES and could produce biased results.     

Family Socioeconomic Status and Adolescent Depressive Symptoms: A Moderated Mediation Model

Low family socioeconomic status (SES) is linked with adolescents’ symptoms of depression, but little is known about the mediating and moderating mechanisms underlying this association. Based on ecosystem theory and the organism-environment interaction model, we tested whether emotional resilience mediated the relationship between family SES and depressive symptoms, and whether parent–child relationship quality moderated the relationship. Adolescents (N?=?724) from one middle school in central China completed self-reported questionnaires regarding demographic variables, family SES, emotional resilience, parent–child relationship quality, and depressive symptoms. Regression-based mediation analysis indicated that emotional resilience mediated the association between family SES and depressive symptoms. Parent–child relationship quality moderated two components of this mediation process, namely the effects of low SES on both emotional resilience and depressive symptoms. In both cases, a high quality parent–child relationship ameliorated the adverse effects of low family SES. That is, adolescents with a higher quality relationship with their parent appeared to be less affected by low family SES. The study reveals how and when family SES may affect adolescents’ depressive symptoms, and highlights the protective effect of a high quality parent–child relationship in a low SES environment.

     

Cognitive biases and obsessive-compulsive symptoms in children: examining the role of maternal cognitive bias and child age

Objective: Multiple cognitive biases associated with adult obsessive-compulsive disorder (OCD) were tested in a clinical sample of children (ages 7-11) and adolescents (12-17) and their mothers. This study examined (a) the associations between child cognitive biases and OCD severity, (b) maternal cognitive biases and child OCD severity, and (c) maternal cognitive bias and child cognitive bias. It was hypothesized that age would significantly moderate these relationships, with stronger associations with OCD severity for cognitive bias in adolescents (relative to children), and maternal cognitive bias in younger children (relative to adolescents). Method: Forty-six children and adolescents diagnosed with OCD and their mothers completed questionnaires assessing responsibility bias, thought-action fusion (TAF), thought suppression, and metacognitive beliefs. OCD symptoms were assessed using structured diagnostic interviews and semistructured symptom interviews. Results: As predicted, age significantly moderated associations between (a) child cognitive variables and OCD severity-specifically between child responsibility and child metacognition, which were associated with OCD severity for adolescents only; (b) maternal cognitive biases and child OCD severity-specifically for maternal responsibility and thought suppression, which were significantly and positively associated with child OCD severity but not adolescent OCD severity; and (c) maternal cognitive biases and child cognitive bias-such that significant associations were evident only in the younger child sample, and only between maternal TAF self and metacognition, with child suppression and child TAF moral, respectively. Conclusion: Maternal cognitive biases are more consistently linked to greater OCD severity among younger children, whereas personal cognitive biases are associated with greater OCD symptoms in adolescents. Treatments for pediatric OCD are likely to be improved by age-specific considerations for the role of maternal and child cognitive biases associated with OCD.     

Is the Association of ADHD with Socio-Economic Disadvantage Explained by Child Comorbid Externalizing Problems or Parent ADHD?

It has been unclear whether an associations of child ADHD with socio-economic disadvantage (SES) could be accounted for by (a) parental ADHD explaining both low SES and child ADHD, and/or (b) the joint overlap of ODD or CD with low SES and ADHD. Study 1 used a community-recruited case-control sample with detailed evaluation of SES indicators, child ADHD, child externalizing, and parent ADHD symptoms (n = 931 children, 521 ADHD, 577 boys, 354 girls) in a path modeling analysis with latent variables. Study 2 evaluated ADHD and externalizing behavior in a regression model using a poverty index for SES, in 70,927 children (48.2% female) aged 5–17 years from the US 2011–2012 National Survey of Children’s Health (NSCH). In Study 1, lower SES was related to the ADHD latent variable, β = ?.18, p < .001; 95%CI [?.25,-.12]. This effect held when parent ADHD and child ODD and CD were in the model, β = ?.11, p < .01, 95% CI [?.09,-.03], equivalent to OR = 1.50, 95% CI[1.12–2.04]). In Study 2, these results replicated. Adjusting only for age and sex, children from families who were below 200% of the federal poverty line were more likely to have moderate or severe ADHD than no ADHD, versus children above that line, OR = 2.13, 95% CI[1.79,2.54], p < .001. The effect held after adjusting for disruptive/externalizing problems, OR = 1.61, p < .01, 95%CI [1.32,1.96]. The effect size for comparable models was similar across both studies, lending higher confidence to the results. It is concluded that the SES association with child ADHD is not explained by artifact and requires a mechanistic explanation.     

Parent and Family Characteristics and Their Associates in a Follow-Up of Outpatient Children with ADHD

We examined associations between child symptoms, demographic variables, parent and family characteristics in a long-term follow-up study of 214 outpatient children with attention-deficit/hyperactivity disorder (ADHD). The children’s mean age was 12.6 (SD = 2.1) years, and the mean interval from diagnosis to follow-up was 3.7 (SD = 2.2) years. We compared the characteristics of the clinical group with a community group (n = 110) recruited from the same catchment area. Parents filled out questionnaires on child symptoms, parent characteristics, and family functioning. The results showed that parents of young boys (<13 years) experienced more parenting stressors than those of adolescent boys (≥13 years), but the opposite was true for parents of girls. Parents of children with both ADHD and oppositional defiant disorder symptoms in the clinical range experienced significantly more parent and family dysfunctions than those of children with ADHD only (even after controlling for levels of ADHD symptoms in the child). Parents of children in the community group experienced significantly less parent and family dysfunctions than those of children with ADHD. Partial correlations between parent characteristics and child symptoms showed that oppositional symptoms were most strongly associated with parent and family dysfunction. Fathers experienced significantly less parenting stress, parental efficacy, and child involvement than mothers. We conclude that parents of children with ADHD experienced considerable strain related to a broad range of parent and family characteristics. Assessment of such characteristics should be part of routine assessment procedures and a prerequisite for family-focused treatment of children with ADHD.     

Sleep-Related Problems in Pediatric Obsessive-Compulsive Disorder and Intensive Exposure Therapy

Limited research has examined sleep-related problems (SRPs) among children and adolescents with obsessive-compulsive disorder (OCD). The present study addresses this gap by investigating preliminary associations between SRPs, demographic factors (gender and age), family variables (family accommodation and parental stress), and clinical factors (medication status, internalizing and externalizing symptoms, OCD severity, OCD-related impairment), and treatment outcomes in a sample of 103 youth (aged 7 to 17 years; 53% female) with a primary diagnosis of OCD. Clinician, parent, and child measures were used to assess demographic, family, and clinical predictors. SRPs were assessed using an 8-item measure comprising items of the Child Behaviour Checklist, Child Depression Inventory, and Multidimensional Anxiety Scale for Children as used in previous studies. Results showed that SRPs were highly prevalent among this sample and that more SRPs were associated with younger age, internalizing problems, and functional impairment. However, SRPs were not an independent predictor of OCD severity, impairment, or treatment response. Preliminary findings suggest that SRPs among youth with OCD may be more strongly associated with broader internalizing symptoms than with OCD itself. Future longitudinal research is warranted to further explore the complexity of SRPs when co-occurring with pediatric OCD.     

Preschoolers with Asthma: Narratives of Family Functioning Predict Behavior Problems

This study tested a model predicting behavior symptoms in preschoolers with asthma. Specifically, it examined the role that asthma severity and children's representations of family functioning may play in the development of child behavior problems in a sample of 53 low-income preschoolers. The study included parent report of asthma severity and a narrative story-stem method to assess children's representations of both general and disease-specific family processes. A regression model tested the inclusion of both types of family processes in predicting child internalizing and externalizing behavior. Disease severity and children's family narratives independently predicted children's behavior over and above the combined effects of demographic variables including child age, socioeconomic status, and family structure. Although children's narratives about general family functioning predicted children's behavior, narratives about family response to asthma symptoms did not. Findings support that both disease severity and family functioning are important considerations in understanding children's behavior problems in the context of asthma. Clinical applications of findings may include: (1) Informing family based-assessments to incorporate children's narratives, and (2) A focus on reducing asthma symptoms and strengthening family functioning to prevent or address child behavior problems.     

Early Fathering as a Predictor of Later Psychosocial Functioning Among Preschool Children with Behavior Problems

The present study examined the role of early fathering in subsequent trajectories of social emotional and academic functioning of preschool children with behavior problems. Participants were 128 preschool-aged children (73 boys, 55 girls) with behavior problems whose biological fathers took part in a longitudinal study. Children were 3 years of age at the beginning of the study and were assessed annually for 3 years. Early paternal depressive symptoms predicted many aspects of children’s outcome 3 years later, including externalizing and internalizing problems, social skills deficits, and lower cognitive and academic functioning, and predicted changes in children’s externalizing, internalizing, and social problems across the preschool years. Paternal socioeconomic status (SES) also consistently predicted children’s later functioning across these domains. Furthermore, self-reported paternal attention-deficit hyperactivity disorder (ADHD) symptoms and laxness, as well as observed frequent commands were associated with later externalizing problems in children. Paternal depressive symptoms and laxness mediated the relation between paternal ADHD symptoms and child functioning. Results suggest that aspects of early father functioning play an important role in the psychosocial, cognitive, and academic development of preschool-aged children with behavior problems.     

Well-Being’s Relation to Religiosity and Spirituality in Children and Adolescents in Zambia

The relations among dimensions of subjective well-being (i.e., happiness and life satisfaction), spirituality and religiousness were assessed in children (aged 7–12, n = 391) and adolescents (aged 13–19, n = 902) in Zambia. These participants were sampled from schools in both urban and rural regions that represented a relatively wide range of affluence. Participants self-reported their happiness using the Faces Scale and the Subjective Happiness Scale, and their life satisfaction using the Student Life Satisfaction Scale. The surveys were available in English as well as two local languages, and were delivered in classroom settings. To assess religiosity, participants were asked about the frequency that they attended church and about the importance of religion in their life. To assess spirituality, participants were asked about whether they considered themselves to be a spiritual person and about the nature domain of spirituality (e.g., “I feel connected to nature”). Results indicated that age, gender, grade and religiosity were not strong predictors of children’s well-being. However, spirituality accounted for 21 % of the variance in life satisfaction beyond these demographic variables and religiosity, but did not account for additional variance in happiness. The results were similar for adolescents except that the demographic variables were weakly predictive of their life satisfaction, and religiosity was a modest predictor of their happiness. Spirituality predicted variance in happiness and life satisfaction more so among adolescents than among children. These results confirm earlier work showing that spirituality, but not necessarily religiosity, is associated with children’s and adolescents’ well-being.     

The Relationships of Family Socioeconomic Status, Parent–Adolescent Conflict, and Filial Piety to Adolescents’ Family Functioning in Mainland China

This study used structural equation modeling to examine the relationships of family socioeconomic status (SES), parent–adolescent conflict, and filial piety to family functioning among middle school and high school students in mainland China. A total of 2,341 students (1,218 girls and 1,096 boys; mean age = 15.42) completed the Chinese Family Assessment Instrument, Family Status Survey, Parent–adolescent Conflict Scale, and Filial Piety Scale. The main results showed that: (a) family SES, parent–adolescent conflict, and filial piety were significantly linked to family functioning; (b) parent–adolescent conflict and filial piety contributed more to family functioning than family SES; (c) parent–adolescent conflict mediated the relationship between reciprocal filial piety and family functioning. The results promote understanding of family processes that influence the relationships between family SES, parent–adolescent conflict, filial piety, and family functioning among middle school and high school adolescents in mainland China.     

Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment

Despite the increasing number of studies on the health-related quality of life (HRQOL) of children with type 1 diabetes (T1D), little is known about the influence of family and parental factors on this outcome. This study aimed to explore whether family cohesion and children’s HRQOL were connected through three indicators of parental psychological adjustment (parenting stress, depressive symptoms, and anxious symptoms) as well as whether these links varied according to the child’s age. Levels of family cohesion, parenting stress, and depression/anxiety symptoms of parents of children with T1D and parents of healthy children were compared. The sample included 88 child–parent dyads composed of children/adolescents (8–18 years old) with T1D and one of their parents and 121 dyads composed of healthy children/adolescents and one of their parents. The parents completed self-report measures of family cohesion, parenting stress, and emotional adjustment, and the children completed measures of HRQOL. Testing of the hypothesized moderated mediational model showed that higher HRQOL ratings in children were associated with higher levels of cohesion through lower levels of parental stress, regardless of the child’s age. Parents of children with T1D perceived less cohesion and felt more anxiety and stress about parenting tasks compared to parents of healthy children. Our findings suggest that parents of children with T1D are at an increased risk of psychological maladjustment. Moreover, this study highlights the interrelation between family/parental functioning and child adjustment and makes an innovative contribution by identifying a mechanism that may account for the link between family and child variables.     

Parenting Stress through the Lens of Different Clinical Groups: a Systematic Review &amp; Meta-Analysis

Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child.     

Discrepancies Between Parent and Adolescent Beliefs About Daily Life Topics and Performance on an Emotion Recognition Task

Parents and children and adolescents commonly disagree in their perceptions of a variety of behaviors, including the family relationship and environment, and child and adolescent psychopathology. To this end, numerous studies have examined to what extent increased discrepant perceptions—particularly with regard to perceptions of the family relationship and environment—predict increased child and adolescent psychopathology. Parents’ and children and adolescents’ abilities to decode and identify others’ emotions (i.e., emotion recognition) may play a role in the link between discrepant perceptions and child and adolescent psychopathology. We examined parents’ and adolescents’ emotion recognition abilities in relation to discrepancies between parent and adolescent perceptions of daily life topics. In a sample of 50 parents and adolescents ages 14-to-17 years (M?=?15.4 years, 20 males, 54 % African-American), parents and adolescents were each administered a widely used performance-based measure of emotion recognition. Parents and adolescents were also administered a structured interview designed to directly assess each of their perceptions of the extent to which discrepancies existed in their beliefs about daily life topics (e.g., whether adolescents should complete their homework and carry out household chores). Interestingly, lower parent and adolescent emotion recognition performance significantly related to greater parent and adolescent perceived discrepant beliefs about daily life topics. We observed this relation whilst accounting for adolescent age and gender and levels of parent-adolescent conflict. These findings have important implications for understanding and using informant discrepancies in both basic developmental psychopathology research and applied research in clinic settings (e.g., discrepant views on therapeutic goals).     

Improving Parental Competencies: Subjectively Perceived Usefulness of a Parent Training Matters

As parental competencies are of importance for the development of children, these competencies are often fostered in parent training programs. Research suggests that a lack of fit between training contents and parental perceptions and expectations might result in a lower effectiveness of a parent training. Consequently, parents’ subjective perceptions of trainings should be in the focus of research on the effects of parent trainings. The present study evaluated the effectiveness of a parent training (MonteBaRo-Training) and analyzed pre-post-test changes. Parents who participated in the program (N = 117) and a waiting list control group (N = 88) were surveyed about children’s behavior problems, parenting sense of competence and dysfunctional parenting at two measurement occasions. Results indicated that the training was effective in improving parenting sense of competence, the perceptions of child problem behavior and dysfunctional parenting. Subjectively perceived usefulness of the training was associated with a change in children’s behavior problems and the parenting sense of competence after the completion of the course.     

Moderators of Parent Training for Disruptive Behaviors in Young Children with Autism Spectrum Disorder

We conducted a 6 month, randomized trial of parent training (PT) versus a parent education program (PEP) in 180 young children (158 boys, 22 girls), ages 3–7 years, with autism spectrum disorder (ASD). PT was superior to PEP in decreasing disruptive and noncompliant behaviors. In the current study, we assess moderators of treatment response in this trial. Thirteen clinical and demographic variables were evaluated as potential moderators of three outcome variables: the Aberrant Behavior Checklist-Irritability subscale (ABC-I), Home Situations Questionnaire (HSQ), and Clinical Global Impressions-Improvement Scale (CGI-I). We used an intent-to-treat model and random effects regression. Neither IQ nor ASD severity moderated outcome on the selected outcome measures. Severity of Attention Deficit Hyperactivity Disorder (ADHD) and anxiety moderated outcomes on the ABC-I and HSQ. For instance, there was a 6.6 point difference on the ABC-I between high and low ADHD groups (p?=?.05) and a 5.3 point difference between high and low Anxiety groups (p?=?.04). Oppositional defiant disorder symptoms and household income moderated outcomes on the HSQ. None of the baseline variables moderated outcome on the CGI-I. That IQ and ASD symptom severity did not moderate outcome suggests that PT is likely to benefit a wide range of children with ASD and disruptive behavior.     

The Relationship Between Parent and Child Dysfunctional Beliefs About Sleep and Child Sleep

Cognitive theories emphasise the role of dysfunctional beliefs about sleep in the development and maintenance of sleep-related problems (SRPs). The present research examines how parents’ dysfunctional beliefs about children’s sleep and child dysfunctional beliefs about sleep are related to each other and to children’s subjective and objective sleep. Participants were 45 children aged 11–12 years and their parents. Self-report measures of dysfunctional beliefs about sleep and child sleep were completed by children, mothers and fathers. Objective measures of child sleep were taken using actigraphy. The results showed that child dysfunctional beliefs about sleep were correlated with father (r = 0.43, p < 0.05) and mother (r = 0.43, p < 0.05) reported child SRPs, and with Sleep Onset Latency (r = 0.34, p < 0.05). Maternal dysfunctional beliefs about child sleep were related to child SRPs as reported by mothers (r = 0.44, p < 0.05), and to child dysfunctional beliefs about sleep (r = 0.37, p < 0.05). Some initial evidence was found for a mediation pathway in which child dyfunctional beliefs mediate the relationship between parent dysfunctional beliefs and child sleep. The results support the cognitive model of SRPs and contribute to the literature by providing the first evidence of familial aggregation of dysfunctional beliefs about sleep.     

Health Related Quality of Life in Children with Congenital Heart Disease

Health-related quality of life in children with congenital heart disease (CHD) was compared to that of healthy children. Furthermore, agreement between child and parent reports was examined. In addition, differences in quality of life related to the severity of CHD were evaluated. One hundred children with CHD aged between 8-18 years and their parents answered a health-related quality of life-questionnaire during their visit to the paediatric cardiology outpatient department. CHD children reported reduced motor functioning and autonomy compared to healthy children. Parents of children with CHD reported their children to have a reduced quality of life in the domains of: motor functioning, autonomy and cognitive functioning. Agreement between child and parent reports was moderate. Children systematically reported lower health related quality of life on the domain of positive emotions than did parents. Health related quality of life in children with CHD appeared not to be influenced by severity of the disease. In conclusion, regardless of the severity of the disease, children with CHD reported their health related quality of life on several domains to be lower than that of healthy children. This means that on several domains, the emotional impact of problems in health status is greater for children with CHD than for healthy children. When CHD patients visit the clinic, it is important that physicians actively ask patients as well as parents about the child's motor functioning, autonomy and cognitive functioning. Children with problems in these domains can then be identified, and psychological interventions can take place at an early stage.