Do parenting and the home environment, maternal depression, neighborhood, and chronic poverty affect child behavioral problems differently in different racial-ethnic groups?

Residential Instability, Family Support, and Parent-Child Relationships Among Ethnically Diverse Urban Families

From a social disorganization standpoint, neighborhood residential instability potentially brings negative consequences to parent-child relationship qualities, but family social support and racial/ethnic identity may modify this association. Using data (n = 3,116) from the Project on Human Development in Chicago Neighborhoods, this study examines associations between neighborhood residential instability and parent-child warmth and conflict, whether family social support moderates associations between residential instability and parent-child relationships, and variation by race/ethnicity. Multilevel models reveal that residential instability undermines parent-child relationship qualities, particularly for non-White individuals. Family support is a protective factor for families in less stable neighborhoods, and specifically buffers the association between neighborhood residential instability and reduced parent-child warmth. Among Hispanics, family support mitigates the association between residential instability and heightened parent-child conflict. Findings highlight residential instability as a detriment to parent-child relationships; families in unstable neighborhoods may benefit from family social support.

Sexual intercourse among adolescent daughters of mothers with depressive symptoms from minority families

This study investigated the association between maternal depressive symptoms and adolescent engagement in sexual intercourse in a non-clinical sample of mothers and their adolescent daughters from minority families. The current study explores ways in which maternal depression, family factors, and adolescent sex interact. Data were from a cross-sectional study of 176 mother-daughter dyads, including a subset of mothers with HIV. Logistic regression analyses revealed that among mothers who were not current marijuana users, more maternal depressive symptoms was associated with daughters' engagement in sexual intercourse. Neither parent-child conflict nor parental involvement significantly mediated the relationship between maternal depressive symptoms and adolescent sex. This study provides the first empirical evidence that non-clinical depressive symptoms in mothers are associated with adolescent engagement in sexual intercourse.

Access to care for children with emotional/behavioral difficulties

Emotional/behavioral difficulties (EBDs) are increasingly diagnosed in children, constituting some of the most common chronic childhood conditions. Left untreated, EBDs pose long-term individual and population-level consequences. There is a growing evidence of disparities in EBD prevalence by various demographic characteristics. This article builds on this research by examining disparities in access to medical care for children with EBD. From 2008 to 2011, using data from the US National Health Interview Survey (N = 31,631) on sample children aged 4-17, we investigate (1) whether having EBD affects access to care (modeled as delayed care due to cost and difficulty making an appointment) and (2) the role demographic characteristics, health insurance coverage, and frequency of service use play in access to care for children with EBD. Results indicate that children with EBD experience issues in accessing care at more than twice the rate of children without EBD, even though they are less likely to be uninsured than their counterparts without EBD. In multivariable models, children with EBD are still more likely to experience delayed care due to cost and difficulty making a timely appointment, even after adjusting for frequency of health service use, insurance coverage, and demographic characteristics.

Direct and Indirect Effects of Behavioral Parent Training on Infant Language Production

Given the strong association between early behavior problems and language impairment, we examined the effect of a brief home-based adaptation of Parent-child Interaction Therapy on infant language production. Sixty infants (55% male; mean age 13.47±1.31 months) were recruited at a large urban primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the home-based parenting intervention or standard pediatric primary care. The observed number of infant total (i.e., token) and different (i.e., type) utterances spoken during an observation of an infant-led play and a parent-report measure of infant externalizing behavior problems were examined at pre- and post-intervention and at 3- and 6-month follow-ups. Infants receiving the intervention demonstrated a significantly higher number of observed different and total utterances at the 6-month follow-up compared to infants in standard care. Furthermore, there was an indirect effect of the intervention on infant language production, such that the intervention led to decreases in infant externalizing behavior problems from pre- to post-intervention, which, in turn, led to increases in infant different utterances at the 3- and 6-month follow-ups and total utterances at the 6-month follow-up. Results provide initial evidence for the effect of this brief and home-based intervention on infant language production, including the indirect effect of the intervention on infant language through improvements in infant behavior, highlighting the importance of targeting behavior problems in early intervention.

When can parents most influence their child's development? Expert knowledge and perceived local realities

Compelling evidence for the long-term impact of conditions in gestation and early childhood on both physical and psychosocial functioning and productivity has stimulated a focus in global health policy and social services on the "first 1000 days". Consequently, related initiatives may assume that rationale for this orientation and the agency of parents during this period is self-evident and widely shared among parents and communities. In 2012, we tested this assumption among a sample of 38 township-dwelling caregivers in Cape Town, by asking a question identified during a study of cultural models of parenting, namely: At what age or stage can a parent or caregiver have the most influence on a child's development? Formal cultural consensus analysis of responses met criteria for strong agreement that the period for greatest impact of parenting on a child's development occurs at adolescence, at a median age of 12 years. In follow-up focus groups and structured interviews, caregivers articulated clear ecological and developmental reasons for this view, related to protection both of developmental potential and against powerful, context-specific ecological risks (early pregnancy, substance ab/use, violence and gangs) that emerge during adolescence. Such risks threaten educational attainment, reproductive health, and social derailment with enduring consequences for lifetime well-being that caregivers are highly motivated to prevent. Developmental needs in pregnancy and early childhood, by contrast, were considered more manageable. These findings resonate with emerging evidence for multiple sensitive periods with corresponding developmental needs, and urge the value of complementing efforts to optimize early development with those to sustain and enhance it during later windows of developmental opportunity such as adolescence. Our results also indicate the need to consult local views of developmental risk and parenting practice in communicating with caregivers and planning interventions, and the value of using available methodological tools to do so.

Psychological functioning among vertically infected HIV-positive children and their primary caregivers

The current study sought to explore the association between primary caregiver depressive symptoms and the psychological functioning in children vertically infected with human immunodeficiency virus (HIV) living in Eastern Cape, South Africa. A cross-sectional data were collected using the Beck Depression Inventory and Strength and Difficulties Questionnaire in a sample of 152 caregiver/child dyads. The results revealed that poorer psychological functioning in children was significantly associated with depressive symptoms in caregivers. This relationship existed whether or not the child was raised by a biological or non-biological caregiver as well as for both genders. Younger children's psychological functioning was more negatively influenced than that of older children raised by a caregiver with depressive symptoms. In the context of a large treatment gap for common mental disorders in South Africa, there is a need for interventions to address maternal mental health in families infected and affected by the HIV/AIDS pandemic as a mental health promotion strategy given that HIV-infected children are a particularly vulnerable population for poor mental and behavioural health outcomes.

Tobacco Use Among Siblings of Childhood Cancer Survivors: A Report From the Childhood Cancer Survivor Study

BACKGROUND

Having a brother or sister with childhood cancer may influence health behaviors during adulthood. The aim of this study was to compare tobacco use in siblings of survivors with peers and to identify factors associated with sibling tobacco use.

PROCEDURES

A retrospective cohort study was conducted using adult siblings (N = 1,974) of 5+ year cancer survivors in the Childhood Cancer Survivor Study (CCSS) and participants (N = 24,105, weighted to match CCSS) in the 2007 National Health Interview Survey. Self-reported tobacco use, sociodemographic, and cancer-related risk factors were analyzed.

RESULTS

Siblings were equally likely to have ever smoked compared to their peers (odds ratio [OR] 1.02, 95% confidence interval [CI] 0.93-1.12). Siblings were less likely to be current smokers (OR 0.83, 95%CI 0.73-0.94), but more likely to be former smokers (OR 1.21, 95%CI 1.08-1.35). Siblings with low education were more likely to ever smoke (OR 1.51, 95%CI 1.15-2.00) and be current smokers (OR 1.67, 95%CI 1.24-2.26) compared to their peers. Among siblings, risk factors for current tobacco use included the following: low income <$20,000 (OR 1.66, 95%CI 1.09-2.54), low education (OR 6.68, 95%CI 4.07-10.97), psychological distress (OR 5.36, 95%CI 2.21-13.02), and heavy alcohol use (OR 3.68, 95%CI 2.50-5.41).

CONCLUSIONS

Siblings of survivors take up smoking at similar rates to their peers, but are more likely to quit. Efforts are needed to address disparities by providing greater psychosocial support and education for the lowest socioeconomic status families facing childhood cancer.

Parental Debt and Children's Socioemotional Well-being

OBJECTIVES

We estimated associations between total amount of parental debt and of home mortgage, student loan, automobile, and unsecured debt with children's socioemotional well-being.

METHODS

We used population-based longitudinal data from the National Longitudinal Study of Youth 1979 Cohort and Children of the National Longitudinal Study of Youth 1979 Cohort. Our analytic sample consisted of 29 318 child-year observations of 9011 children and their mothers observed annually or biennially from 1986 to 2008. We used the Behavioral Problems Index to measure socioemotional well-being. We used ordinary least squares regressions to estimate between-child associations of amounts and types of parental debt with socioemotional well-being, net of a host of control variables, and regressions with child-specific fixed effects to estimate within-child associations of changes in parental debt with changes in socioemotional well-being, net of all time-constant observed and unobserved confounders.

RESULTS

Greater total debt was associated with poorer child socioemotional well-being. However, this association varied by type of debt. Specifically, higher levels of home mortgage and education debt were associated with greater socioemotional well-being for children, whereas higher levels of and increases in unsecured debt were associated with lower levels of and declines in child socioemotional well-being.

CONCLUSIONS

Debt that allows for investment in homes (and perhaps access to better neighborhoods and schools) and parental education is associated with greater socioemotional well-being for children, whereas unsecured debt is negatively associated with socioemotional development, which may reflect limited financial resources to invest in children and/or parental financial stress. This suggests that debt is not universally harmful for children's well-being, particularly if used to invest in a home or education.

Constructing and Adapting Causal and Formative Measures of Family Settings: The HOME Inventory as Illustration

Measures of the home environment are frequently used in studies of children's development. This review provides information on indices composed of causal and formative indicators (the kind of indicators often used to capture salient aspects of family environments) and to suggest approaches that may be useful in constructing such measures for diverse populations. The HOME Inventory is used to illustrate challenges scholars face in determining what to include in useful measures of family settings. To that end, a cross-cultural review of research on relations among HOME, family context, and child outcomes is presented. The end of the review offers a plan for how best to further research on relations between the home environment and child development for diverse populations.

Putting Families Into Place: Using Neighborhood-Effects Research and Activity Spaces to Understand Families

Neighborhood is an important context in which individuals and families are embedded. Yet family studies researchers have been relatively slow to incorporate spatial approaches into family science. Although limited theoretical and methodological attention has been devoted to families in neighborhood-effects research, family scholars can contribute greatly to theories about neighborhood effects, and neighborhood-effects research can help move the field of family studies forward. This article reviews the theories, applications, and limitations of research on neighborhood effects and discusses how family studies can benefit from incorporating a spatial perspective from neighborhood-effects research. I then present an innovative methodology-referred to as activity spaces-emerging in neighborhood-effects research, and I discuss how this approach can be used to better understand the complexity and heterogeneity of families. Last, I highlight ways to incorporate space into family studies by "putting families into place."

Maternal depression symptoms, unhealthy diet and child emotional-behavioural dysregulation

BACKGROUND

Maternal depression and unhealthy diet are well-known risk factors for adverse child emotional-behavioural outcomes, but their developmental relationships during the prenatal and postnatal periods are largely uncharted. This study sought to examine the inter-relationships between maternal depression symptoms and unhealthy diet (assessed during pregnancy and postnatal periods) in relation to child emotional-behavioural dysregulation (assessed at the ages of 2, 4 and 7 years).

METHOD

In a large prospective birth cohort of 7814 mother-child pairs, path analysis was used to examine the independent and inter-related associations of maternal depression symptoms and unhealthy diet with child dysregulation.

RESULTS

Higher prenatal maternal depression symptoms were prospectively associated with higher unhealthy diet, both during pregnancy and the postnatal period, which, in turn, was associated with higher child dysregulation up to the age of 7 years. In addition, during pregnancy, higher maternal depression symptoms and unhealthy diet were each independently associated with higher child dysregulation up to the age of 7 years. These results were robust to other prenatal, perinatal and postnatal confounders (such as parity and birth complications, poverty, maternal education, etc.).

CONCLUSIONS

Maternal depression symptoms and unhealthy diet show important developmental associations, but are also independent risk factors for abnormal child development.

Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh

BACKGROUND

Maternal depression is associated with poor child development and growth in low-income countries. This paper evaluates the effect of a community-based trial providing psychosocial stimulation and food supplements to severely malnourished children on maternal depressive symptoms in Bangladesh.

METHODS

Severely underweight (weight-for-age Z-score < -3) hospitalized children aged 6-24 months (n = 507), were randomly assigned to: psychosocial stimulation (PS), food supplementation (FS), PS+FS, clinic control (CC) and hospital control (CH) at discharge. PS included play sessions with children and parental counselling to mothers during fortnightly follow-up visit at community clinics, conducted by trained play leaders for 6 months. FS involved cereal-based supplements (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplements and growth monitoring. We used Bayley scales, Home Observation for Measurement of Environment (HOME) inventory and a parenting questionnaire to assess child development, home stimulation and mothers' child-rearing practices, respectively. We assessed mothers' depressive symptoms using a modified version of Centre for Epidemiologic Studies Depression Scale at baseline and at 6 months post intervention.

RESULTS

Maternal depressive symptoms were significantly lower in the CH group at baseline (P = 0.014). After 6 months of intervention there was no significant effect of intervention after adjusting for baseline scores and all possible confounders. Maternal depressive symptoms were higher among poorer (P = 0.06), older (P = 0.057) and less educated (P = 0.019) mothers, who were housewives (P = 0.053), and whose husbands had more unstable jobs (P = 0.058). At 6 months post intervention, children's cognitive (P = 0.045) and motor (P = 0.075) development, HOME (P = 0.012) and mother's parenting score (P = 0.057) were higher among mothers with lower depressive symptoms.

CONCLUSION

The study did not show a significant effect of the intervention on the level of maternal depressive symptoms. Interventions with higher intensity and/or of longer duration focusing directly on maternal psychosocial functioning are probably needed to reduce maternal depressive symptoms.

Cost-effectiveness of Legacy for Children™ for Reducing Behavioral Problems and Risk for ADHD among Children Living in Poverty

This paper describes the programmatic costs required for implementation of the Legacy for Children™ (Legacy) program at two sites (Miami and Los Angeles) and enumerate the cost-effectiveness of the program. Legacy provided group-based parenting intervention for mothers and children living in poverty. This cost-effectiveness analysis included two behavioral outcomes, behavioral problems, and attention-deficit/hyperactivity disorder (ADHD), and programmatic costs collected prospectively (2008 US$). Incremental costs, effects, the incremental cost-effectiveness ratio (ICER), and cost-effectiveness acceptability curves were estimated for the intervention groups relative to a comparison group with a 5 year analytic horizon. The intervention costs per family for Miami and Los Angeles were $16,900 and $14,100, respectively. For behavioral problems, the incremental effects were marginally significant (p=0.11) for Miami with an ICER of $178,000 per child at high risk for severe behavioral problems avoided. For ADHD, the incremental effects were significant (p=0.03) for Los Angeles with an ICER of $91,100 per child at high risk for ADHD avoided. Legacy was related to improvements in behavioral outcomes within two community-drawn sites and the costs and effects are reasonable considering the associated economic costs.

Temperament as a moderator of the effects of parenting on children's behavior

This study examined the role of child temperament as moderator of the effect of parenting style on children's externalizing and internalizing behaviors. A series of structural equation models were fit to a representative sample of 2,631 Canadian children from the National Longitudinal Survey of Children and Youth. In addition to testing for the presence of Temperament × Parenting interactions, these models also examined the direct and indirect effects of a number of additional contextual factors such as neighborhood problems, neighborhood cohesion, social support, and maternal depression. The results indicate that exposure to more positive parenting reduces behavior problems in children with difficult/unadaptable temperaments. No moderating effects of temperament on hostile parenting were found. Such results serve to highlight the pivotal role of positive features of the rearing environment as catalysts for the successful adaptation of children with difficult/unadaptable temperaments. The results of this modeling work also serve to emphasize the importance of considering the ways in which more distal factors can affect children's behavioral adaptation by contributing to changes in proximal family processes.

Does neighborhood social capital buffer the effects of maternal depression on adolescent behavior problems?

Neighborhood characteristics have been shown to impact child well-being. However, it remains unclear how these factors combine with family characteristics to influence child development. The current study helps develop that understanding by investigating how neighborhoods directly impact child and adolescent behavior problems as well as moderate the influence of family characteristics on behavior. Using multilevel linear models, we examined the relationship among neighborhood conditions (poverty and social capital) and maternal depression on child and adolescent behavior problems. The sample included 741 children, age 5–11, and 564 adolescents, age 12–17. Outcomes were internalizing (e.g. anxious/depressed) and externalizing (e.g. aggressive/hyperactive) behavior problems. Neighborhood poverty and maternal depression were both positively associated with behavior problems for children and adolescents. However, while neighborhood social capital was not directly associated with behavior problems, the interaction of social capital and maternal depression was significantly related to behavior problems for adolescents. This interaction showed that living in neighborhoods with higher levels of social capital attenuated the relationship between maternal depression and adolescent behavior problems and confirmed the expectation that raising healthy well-adjusted children depends not only on the family, but also the context in which the family lives.

Distributional effects of Oportunidades on early child development

The Mexican Oportunidades program is designed to increase human capital through investments in education, health, and nutrition for children in extreme poverty. Although the program is not expressly designed to promote a child's cognitive and non-cognitive development, the set of actions carried out by the program could eventually facilitate improvements in these domains. Previous studies on the Oportunidades program have found little impact on children's cognition but have found positive effects on their non-cognitive development. However, the majority of these studies use the average outcome to measure the impact of the program and thus overlook other "non-average" effects. This paper uses stochastic dominance methods to investigate results beyond the mean by comparing cumulative distributions for both children who are and children who are not aided by the program. Four indicators of cognitive development and one indicator of non-cognitive development are analyzed using a sample of 2595 children aged two to six years. The sample was collected in rural communities in Mexico in 2003 as part of the program evaluation. Similar to previous studies, the program is found to positively influence children's non-cognitive abilities: children enrolled in the program manifest fewer behavioral problems compared with children who are not enrolled. In addition, different program effects are found for girls and boys and for indigenous and non-indigenous children. The ranges where the effect is measured cover a large part of the outcome's distribution, and these ranges include a large proportion of the children in the sample. With regard to cognitive development, only one indicator (short-term memory) shows positive effects. Nevertheless, the results for this indicator demonstrate that children with low values of cognitive development benefit from the program, whereas children with high values do not. Overall, the program has positive effects on child development, especially for the most vulnerable, who are at the bottom of the distribution.

Promoting adolescent behavioral adjustment in violent neighborhoods: supportive families can make a difference!

This study examined the moderating effects of family cohesion on the relationship between community violence and child internalizing and externalizing problems at age 18. The study sample consisted of 728 children and families who were part of the Infant Health and Development Program, an intervention study for low-birthweight, preterm infants. Six of eight sites in the Infant Health and Development Program were in large metropolitan areas; two served rural and urban areas. About half of the sample was African American. Research teams collected data from caregivers multiple times in the first 3 years of the target child's life, and at 4, 5, 6½, 8, and 18 years. Caregivers reported on community violence, neighborhood problems with (a) drug users/sellers; (b) delinquent gangs; and (c) crime, assaults, and burglaries reports when children were 4, 5, and 8 years of age. Family cohesion was assessed twice, at ages 6½ and 8 years, using caregiver reports on the Family Environment Scale. Adolescent self-report of Internalizing and Externalizing Behavior Problems at age 18 were assessed using the Behavior Problems Index. In this study, the association between adolescent psychosocial outcomes and community violence were moderated by family cohesion and gender such that being in a highly cohesive family as a child protected male children from the negative effects of community violence. Findings demonstrate the long-term protective effects of family cohesion on child behavioral development for male children but suggest a need to examine additional supports for females exposed to community violence during childhood.

Bicultural Identity Integration of Transracial Adolescent Adoptees

A number of studies have focused on Bicultural Identity Integration (BII) to explore whether and how migrants and ethnic minorities, who experience multiple cultural belongings, perceive their two cultural backgrounds as compatible (vs. conflictual) and to study the impact of these differences on their psychosocial well-being. Nevertheless, there is a lack of research on BII among transracial adoptees, who also experience unique conditions of dual cultural belonging. Relying on a sample of 170 adopted adolescents born in Latin American countries and subsequently adopted in Italy (aged between 15 and 25) and both of their parents, the aim of the present study was twofold: to explore whether and the extent to which BII is related to adoptees’ behavioral problems and to analyze the influence of specific family and social identity variables on BII. Multivariate analyses using the structural equation modeling indicated that adoptive filiation (i.e., belonging to the adoptive family) and parents’ cultural socialization strategies are significant protective factors for national identity and ethnic identity, respectively, which in turn influences adoptees’ behavioral problems, but this relation is mediated by differences in BII.

Testing the temporal relationship between maternal and adolescent depressive and anxiety symptoms in a community sample

Transactional models have been used to explain the relationship between maternal depression and child behavioral problems; however, few studies have examined transactional models for maternal depression and adolescent depression and anxiety. Using an autoregressive cross-lagged analysis, we examined the longitudinal association between maternal and adolescent depression to determine the extent to which maternal depression influences adolescent depression and anxiety, and vice versa, over the course of a 4-year period. Participants were a community sample of 277 mother-adolescent dyads with offspring 10 to 14 years of age at the 1st year used in the analyses (43.7% female; 35% African American, 2.9% Hispanic/Latino). Depressive symptoms were assessed using maternal self-report (Center for Epidemiological Studies-Depression Scale; Radloff, 1977), and adolescent depression and anxiety were assessed by self-report (Revised Child Anxiety and Depression Scale; Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000). The final model, χ(2)(14) = 23.74, p = .05 (TLI = .97, CFI = .98, RMSEA = .05), indicated that maternal depression was significantly associated with adolescent depression 2 years later. Of interest, adolescent depression did not significantly predict maternal depression, and the association between maternal and adolescent depression was not moderated by gender, age, or ethnicity. The association between maternal depression and adolescent anxiety was weaker than that observed for adolescent depression. Results suggest that the transaction model of maternal depression may not extend to adolescent depression and anxiety. Furthermore, maternal depression can have an enduring effect on adolescent depression, and continued research and clinical monitoring over extended periods is warranted.

Parent Training Outcomes among Young Children with Callous-Unemotional Conduct Problems with or At-Risk for Developmental Delay

School-aged children with conduct problems and high levels of callous-unemotional (i.e., lack of empathy, guilt, and lack of caring behaviors) traits (CP+CU) tend to yield less benefit from traditional interventions than do their low-CU counterparts, particularly with respect to CP outcomes. To date, little is known about treatment response among young children with CP+CU, particularly those with or at risk for developmental delay. Components of Parent-Child Interaction Therapy (PCIT), a parent training program effective at reducing CP in young children, have compelling theoretical support for addressing core deficits unique to children with CP+CU and have been used successfully with young children with developmental delay. Our first aim was to test the psychometric properties of a measure of CU traits in preschool children with and without developmental delay. Our second aim was to test whether CU traits predicted post-treatment CP after controlling for initial levels of CP. Participants were 63 families of young children (mean age = 3.87 years), with or at-risk for developmental delay, who presented with elevated CP and were treated in a hospital-based outpatient clinic. Results indicated that developmentally delayed children with high levels of CU traits, but not children at-risk for delay due to premature birth, showed significantly poorer CP outcomes following treatment with PCIT than did children scoring low on CU traits, even after controlling for initial CP severity. The implications of these findings with regard to treating and preventing severe disruptive behaviors among young children with CP+CU are discussed.

Parenting influences on Latino children's social competence in the first grade: parental depression and parent involvement at home and school

Although it is widely accepted that parental depression is associated with problems with children's socioemotional adjustment, the pathways by which parental depression influences children's adjustment, particularly in low-income Latino children are not fully understood. In our investigation of 1,462 low-income Latino children in the first grade and their Spanish- and English-dominant parents, a factor analysis revealed three main pathways of possible influence of parent involvement in children's social development: emotional involvement and educational involvement at home and at school. The findings from multigroup structural equation modeling revealed that whereas the first two pathways mediated the effect of parental depression on child social competence for Spanish-dominant parents, only emotional involvement explained parental depression effects for English-dominant parents. Parent educational involvement at school did not mediate parental depression effects for either Spanish- or English-dominant Latino parents. Discussion and implications of findings with respect to research, practice, and policy with Latinos follow.

Depressão materna e riscos para o comportamento e a saúde mental das crianças: uma revisão

A depressão materna tem sido considerada um fator de risco para a saúde mental das crianças. Objetivou-se identificar e analisar na literatura indexada artigos empíricos recentes (2005 a 2012), que abordaram as associações da depressão materna ao comportamento e à saúde mental de crianças, escolares. Procedeu-se a uma busca sistemática nas bases PubMed, PsycInfo e LILACS, por meio das palavras-chave "Maternal Depression or Depression" e "Risk Factors". Foram selecionados e analisados 68 artigos, 23 transversais e 45 longitudinais. Independentemente dos delineamentos adotados, a depressão materna mostrou-se associada à presença de dificuldades emocionais e comportamentais em geral, de manifestações depressivas e de ansiedade. Além da depressão materna, outras variáveis contextuais mostraram-se associadas às dificuldades das crianças. O reconhecimento da ação de múltiplas variáveis permitiu a verificação de indicadores diversos, o que pode favorecer o planejamento de intervenções.

The effect of post-natal mental distress amongst Indian and Pakistani mothers living in England on children's behavioural outcomes

BACKGROUND

Low socio-economic status (SES), post-natal mental distress and parenting impact child mental health and future well-being. There are unexplained differences in child mental health between South Asian ethnic minority groups living in the UK that may be due to variation in, and differential mediation of, these factors.

METHODS

We used multivariate multiple regression analysis of the effect of symptoms of mental distress, socio-demographic variables and warmth of parenting on child internalizing and externalizing scores at age seven (measured in 2010) in a population cohort of English children whose mothers were of Indian (n = 211) and Pakistani (n = 260) origin.

RESULTS

In the fully adjusted models the legacy of mental distress was visible for both internalizing (β coefficient 1.52, P = 0.04) and externalizing (1.68, P = 0.01) behaviour in the Pakistani children, and on the Indian children's internalizing (2.08, P = 0.008) but not externalizing (0.84, P = 0.204) behaviour. Lower SES was associated with worse behavioural scores for the Pakistani children, and warmth of parenting on Indian children's externalizing scores.

CONCLUSIONS

Symptoms of post-natal mental distress are associated with Indian and Pakistani child outcomes at age seven. The finding that warmth of parenting had a stronger association on Indian children's externalizing scores than mental distress might be explained by differences in the expression of SES on family characteristics and functioning between the two ethnic groups.

Behavioral and socioemotional outcomes through age 5 years of the legacy for children public health approach to improving developmental outcomes among children born into poverty

OBJECTIVES

We evaluated Legacy for Children, a public health strategy to improve child health and development among low-income families.

METHODS

Mothers were recruited prenatally or at the birth of a child to participate in Legacy parenting groups for 3 to 5 years. A set of 2 randomized trials in Miami, Florida, and Los Angeles, California, between 2001 and 2009 assessed 574 mother-child pairs when the children were 6, 12, 24, 36, 48, and 60 months old. Intent-to-treat analyses from 12 to 60 months compared groups on child behavioral and socioemotional outcomes.

RESULTS

Children of mothers in the intervention group were at lower risk for behavioral concerns at 24 months and socioemotional problems at 48 months in Miami, and lower risk for hyperactive behavior at 60 months in Los Angeles. Longitudinal analyses indicated that children of intervention mothers in Miami were at lower risk for behavior problems from 24 to 60 months of age.

CONCLUSIONS

Randomized controlled trials documented effectiveness of the Legacy model over time while allowing for implementation adaptations by 2 different sites. Broadly disseminable, parent-focused prevention models such as Legacy have potential for public health impact. These investments in prevention might reduce the need for later intervention strategies.

Economic disadvantage and young children's emotional and behavioral problems: mechanisms of risk

This study aimed to establish potential mechanisms through which economic disadvantage contributes to the development of young children's internalizing and externalizing problems. Prospective data from fetal life to age 3 years were collected in a total of 2,169 families participating in the Generation R Study. The observed physical home environment, the provision of learning materials in the home, maternal depressive symptoms, parenting stress, and harsh disciplining practices were all analyzed as potential mediators of the association between economic disadvantage and children's internalizing and externalizing problem scores. Findings from structural equation modeling showed that for both internalizing and externalizing problems, the mechanisms underlying the effect of economic disadvantage included maternal depressive symptoms, along with parenting stress and harsh disciplining. For internalizing but not for externalizing problem scores, the lack of provision of learning materials in the home was an additional mechanism explaining the effect of economic disadvantage. The current results suggest that interventions that focus solely on raising income levels may not adequately address problems in the family processes that emerge as a result of economic disadvantage. Policies to improve the mental health of mothers with young children but also their home environments are needed to change the economic gradient in child behavior.

Maternal Depressive Symptoms and Child Behavior Problems among Latina Adolescent Mothers: The Buffering Effect of Mother-reported Partner Child Care Involvement

We examined the relations between maternal depressive symptoms and child internalizing and externalizing problems in a sample of 125 adolescent Latina mothers (primarily Puerto Rican) and their toddlers. We also tested the influence of mother-reported partner child care involvement on child behavior problems and explored mother-reported partner characteristics that related to this involvement. Results suggested that maternal depressive symptoms related to child internalizing and externalizing problems when accounting for contextual risk factors. Importantly, these symptoms mediated the link between life stress and child behavior problems. Mother-reported partner child care interacted with maternal depressive symptoms for internalizing, not externalizing, problems. Specifically, depressive symptoms related less strongly to internalizing problems at higher levels of partner child care than at lower levels. Participants with younger partners, co-residing partners, and in longer romantic relationships reported higher partner child care involvement. Results are discussed considering implications for future research and interventions for mothers, their children, and their partners.

Latino youth's internalising behaviours: links to immigrant status and neighbourhood characteristics

OBJECTIVES

Latinos are the fastest-growing immigrant group in the U.S.A. Yet, little is known about the emotional well-being of this population, such as the links among family, neighbourhood context and Latino immigrant youth mental health. Understanding this link will help determine which contexts negatively impact Latino immigrant youth mental health.

DESIGN

Drawing data from the Project on Human Development in Chicago Neighbourhoods collected in 1994-1995 and 1997-1999, this study examined links between Latino youth's internalising behaviours, based on the Child Behavior Checklist (CBCL), and neighbourhood characteristics as a function of immigrant status. The sample included 1040 (aged 9-17) Latino immigrant youth seen twice over three years and identified as first, second or third generation. In this study, neighbourhoods are made up of two to three census tracts that reflect similar racial/ethnic and socioeconomic composition. Using hierarchical linear regression models, the study also explored links between internalising behaviours and neighbourhood characteristics, including concentrated disadvantage, immigrant concentration and residential stability.

RESULTS

First- and second-generation youth had higher internalising behaviour scores (i.e., worse mental health) than third-generation youth after controlling for youth internalising behaviours at Wave 1, maternal depression and family characteristics. First- and second-generation youth were more likely to live in high immigrant-concentrated neighbourhoods and first-generation youth were more likely to live in residentially unstable neighbourhoods. Controlling for neighbourhood clusters eliminated the immigrant-generation internalising association. However, second-generation Latino youth living in neighbourhoods with higher residential stability had higher levels of internalising behaviour problems compared to first- and third-generation youth living in similar neighbourhoods.

CONCLUSIONS

We found that the interaction between immigrant generation and neighbourhood context helps to explain differences observed in the mental health of second-generation immigrant youth, a result that may help other communities in the USA and other countries better understand the factors that contribute to immigrant youth well-being.

Disentangling the temporal relationship between parental depressive symptoms and early child behavior problems: a transactional framework

Despite the considerable amount of research demonstrating the relationship between parental depressive symptoms and child behavior problems, few studies have examined the direction of the relationship between these variables. Therefore, the purpose of this study was to examine transactional effects between parental depressive symptoms and child behavior problems. Participants were 209 parent-child dyads drawn from the Oregon Adolescent Depression Project who completed at least 2 of 4 annual questionnaire assessments between the child's age of 4 and 7 years. Structural equation modeling was used to examine the autoregressive paths from one year to the next year within each construct, as well as cross-lagged paths from one year to the next year between constructs. Findings indicated that parental depressive symptoms at each year predicted child behavior problems at the subsequent year and vice versa. No support was found for differential gender effects. These findings highlight the reciprocal relationship between parental depressive symptoms and child behavior problems and suggest intervention programs for young children should assess for and target parental depression when appropriate. Future research should examine these relationships across a broader developmental spectrum and in more diverse, heterogeneous samples.

An initial investigation of baseline respiratory sinus arrhythmia as a moderator of treatment outcome for young children born premature with externalizing behavior problems

The aim of the current study was to examine the moderating effect of baseline respiratory sinus arrhythmia (RSA) on Parent-Child Interaction Therapy (PCIT), a behavioral parent-training intervention, for young children born premature. In this pilot randomized controlled trial, 28 young children (mean age of 37.79 months), who were born <37 weeks gestation and presented with elevated externalizing behavior problems, were randomly assigned to an immediate treatment or waitlist control group. RSA, which provides an approximate marker of individual differences in cardiac vagal tone, was measured during a baseline period. Past research has generally shown that higher levels of baseline RSA correlate with various positive psychological states (e.g., empathy, sustained attention), whereas lower levels of baseline RSA correlate with less optimal psychological states (e.g., higher externalizing behavior problems). Results indicated that baseline RSA significantly interacted with treatment condition in predicting changes in child disruptive behavior. Specifically, low levels of baseline RSA were associated with greater improvements in child disruptive behavior following PCIT. While acknowledging the caveats of measuring and interpreting RSA and the need to include a sympathetic-linked cardiac measure in future research, these findings provide preliminary evidence that children with lower capacity for emotion regulation receive even greater treatment gains. Future research should also examine the moderating effect of RSA in larger samples and explore the potential mediating role of RSA on behavioral parenting interventions.

The relationship between environment, efficacy beliefs, and academic achievement of low-income African American children in special education

African American students are overrepresented in special education. Ecological systems theory, social cognitive theory, and a literature review demonstrate that children's environments, particularly school, and self-efficacy impact the educational outcomes of African American children. Interventions have aimed to improve children's environmental resources and efficacy. The aim of this study was to assess the impact of environment, efficacy beliefs, and the Nurse-Family Partnership intervention on the educational achievements of African American children in special education. A secondary data analysis of 126 African American children in special education found that self-efficacy and the number of hours spent in special education were associated with their academic achievement.

Psychological vulnerability among overweight/obese minority adolescents

Depression is associated with obesity among adolescents, with racial/ethnic variability noted. Psychological correlates that may influence this relationship have not been adequately explored. The primary objective of this secondary analysis was to compare levels of stress, self-esteem, coping, social support, and depressive mood between normal weight and overweight/obese minority adolescents (as defined using Centers for Disease Control and Prevention standards). Adolescents (n = 101) aged 14-18 years who were largely minority (87%) were recruited from two Midwestern-area high schools. Using a descriptive comparative design, individuals were grouped into normal weight (>5th to <85th percentile) and overweight/obese (≥ 85 th percentile) for comparison on measures. Self-reported levels of stress, coping, self-esteem, social support, depressive mood, and body mass index were obtained. Obese/overweight adolescents reported significantly lower self-esteem than did those with normal weight (p < .05). Although stress was a significant predictor of depressive mood in both groups (p < .001), low self-esteem was also a significant predictor of depressive mood in the overweight/obese group (p = .001). Strategies to manage stress and improve self-esteem may help alleviate depressive mood in high school adolescents.

A quasi-experimental analysis of the influence of neighborhood disadvantage on child and adolescent conduct problems

A quasi-experimental comparison of cousins differentially exposed to levels of neighborhood disadvantage (ND) was used with extensive measured covariates to test the hypothesis that neighborhood risk has independent effects on youth conduct problems (CPs). Multilevel analyses were based on mother-rated ND and both mother-reported CPs across 4-13 years (n = 7,077) and youth-reported CPs across 10-13 years (n = 4,524) from the Children of the National Longitudinal Survey of Youth. ND was robustly related to CPs reported by both informants when controlling for both measured risk factors that are correlated with ND and unmeasured confounds. These findings are consistent with the hypothesis that ND has influence on conduct problems.

Barriers to health care for chinese in the Netherlands

This study examines utilisation of the Dutch health care system by Chinese people in the Netherlands as well as their attitudes to the system, paying special attention to mental health. Information was gathered by semistructured interviews (n = 102). The main issues investigated are access, help-seeking behaviour, and quality of care. Results showed that most respondents used Dutch health care as their primary method of managing health problems. Inadequate knowledge about the system and lack of Dutch language proficiency impede access to care, in particular registration with a General Practitioner (GP). Users complained that the care given differed from what they expected. Results also showed that the major problems are to be found in the group coming from the Chinese-speaking region. Western concepts of mental health appear to be widely accepted by Chinese in the Netherlands. However, almost half of our respondents believed that traditional Chinese medicine or other methods can also help with mental health problems. The provision of relevant information in Chinese appears to be important for improving access. Better interpretation and translation services, especially for first-generation migrants from the Chinese-speaking region, are also required.

Household exposure to secondhand smoke is associated with decreased physical and mental health of mothers in the USA

Secondhand smoke is one of the most common toxic environmental exposures to children, and maternal health problems also have substantial negative effects on children. We are unaware of any studies examining the association of living with smokers and maternal health. To investigate whether non-smoking mothers who live with smokers have worse physical and mental health than non-smoking mothers who live in homes without smokers. Nationally representative data from the 2000-2004 Medical Expenditure Panel Survey were used. The health of non-smoking mothers with children <18 years (n = 18,810) was assessed, comparing those living with one or more smokers (n = 3,344) to those living in households with no adult smokers (n = 14,836). Associations between maternal health, household smoking, and maternal age, race/ethnicity, and marital, educational, poverty and employment status were examined in bivariable and multivariable analyses using SUDAAN software to adjust for the complex sampling design. Scores on the Medical Outcomes Short Form-12 (SF-12) Physical Component Scale (PCS) and Mental Component Scale (MCS) were used to assess maternal health. About 79.2% of mothers in the USA are non-smokers and 17.4% of them live with ≥1 adult smokers: 14.2% with 1 and 3.2% with ≥2 smokers. Among non-smoking mothers, the mean MCS score is 50.5 and mean PCS is 52.9. The presence of an adult smoker and increasing number of smokers in the home are both negatively associated with MCS and PCS scores in bivariable analyses (P < 0.001 for each). Non-smoking mothers with at least one smoker in the household had an 11% (95% CI = 0.80-0.99) lower odds of scoring at or above the mean MCS score and a 19% (95% CI = 0.73-0.90) lower odds of scoring at or above the mean PCS score compared to non-smoking mothers with no smokers in the household. There is an evidence of a dose response relationship with increasing number of smokers in the household for PCS (P < 0.001). These findings demonstrate a previously unrecognized child health risk: living with smokers is independently associated with worse physical and mental health among non-smoking mothers.

Prenatal cigarette exposure and infant learning stimulation as predictors of cognitive control in childhood

Prenatal exposures to neurotoxins and postnatal parenting practices have been shown to independently predict variations in the cognitive development and emotional-behavioral well-being of infants and children. We examined the independent contributions of prenatal cigarette exposure and infant learning stimulation, as well as their inter-relationships in predicting variations in the proficiency of executive attention, a core element of cognitive control and self-regulation. Participants were an ethnic-racially, socio-economically diverse sample of 249 children followed from birth in the Project on Human Development in Chicago Neighborhoods. We obtained histories of prenatal exposure to alcohol, cigarettes, and other drugs, and we assessed socio-economic status and learning stimulation during a home visit when the participants were infants. In childhood we utilized the Attention Networks Test to assess the proficiency of executive attention during two home visits, one year apart. Accounting for age, SES, prenatal alcohol exposure, and baseline performance, we found that prenatal cigarette exposure impaired the speed of executive attention. Infant learning stimulation mitigated these effects, and predicted better accuracy of executive attention as well, suggestive of both protective and health promoting effects. Effect sizes for these relations, whether examined independently or by their inter-relationships, were comparable to if not greater in magnitude than the effects of age on speed and accuracy, highlighting the importance of these very early experiences in shaping the proficiency of self-regulation. Since executive attention is central to cognitive control and self-regulation, previously described relations between prenatal cigarette exposure, parenting practices, and some forms of childhood psychopathology may be contingent on how early learning stimulation contributes to the proficiency of executive attention through direct and indirect effects. Furthermore, considering the prolonged developmental trajectory of executive attention, interventions to support provision of learning stimulation may mitigate poor outcomes for some at-risk children by promoting development of more proficient executive attention.

Longitudinal associations of maternal depressive symptoms, maternal involvement, and diabetes management across adolescence

OBJECTIVE

To examine whether maternal depressive symptoms: (a) predicted the level of maternal involvement in diabetes management tasks across adolescence; and (b) moderated associations of involvement with adolescent adherence, metabolic control, and depression.

METHODS

Eighty-two youth aged 10-15 years with type 1 diabetes and their mothers completed measures at baseline and 16 months later. Participants rated maternal involvement in diabetes tasks, adherence, and depressive symptoms; metabolic control was indexed from medical records.

RESULTS

Maternal depressive symptoms were associated with higher involvement at baseline, and slower declines in involvement across time. At baseline, involvement was associated with lower adolescent depression and better metabolic control, but this association was stronger when mothers reported fewer depressive symptoms. Interactions of maternal depression with involvement across time suggested maternal involvement was associated with better subsequent adherence primarily when mothers reported fewer depressive symptoms.

CONCLUSIONS

Mothers' depressive symptoms may undermine her care-giving effectiveness during adolescence.

Do Verbal Interactions with Infants During Electronic Media Exposure Mitigate Adverse Impacts on their Language Development as Toddlers?

The goal of this study was to determine whether verbal interactions between mothers and their 6-month-old infants during media exposure ('media verbal interactions') might have direct positive impacts, or mitigate any potential adverse impacts of media exposure, on language development at 14 months. For 253 low-income mother-infant dyads participating in a longitudinal study, media exposure and media verbal interactions were assessed using 24-hour recall diaries. Additionally, general level of cognitive stimulation in the home [StimQ] was assessed at 6 months and language development [Preschool Language Scale-4] was assessed at 14 months. Results suggest that media verbal interactions play a role in the language development of infants from low-income, immigrant families. Evidence showed that media verbal interactions moderated adverse impacts of media exposure found on 14-month language development, with adverse associations found only in the absence the these interactions. Findings also suggest that media verbal interactions may have some direct positive impacts on language development, in that media verbal interactions during the co-viewing of media with educational content (but not other content) were predictive of 14-month language independently of overall level of cognitive stimulation in the home.

Differences in vulnerability factors for depressive episodes in African American and European American adolescents

BACKGROUND

Although intervention tailoring could lower the burden of adolescent depression, few studies have examined differences in vulnerability factors between African American and European American youth.

METHODS

We determined and compared the prevalence, relative risk, and population-attributable risk (PAR) of baseline vulnerability factors predicting depressive episodes at 1-year follow-up in a nationally representative sample of African American and European American adolescents.

RESULTS

The leading (highest PAR) vulnerability factors for African American adolescents were demographics, while the top vulnerability factors for European American youth were current depressed affect and low perceived family connectedness. Unique vulnerability factors for African American youth were (1) neither parent finished high school, (2) believing oneself unintelligent, and (3) running away from home. Avoidant problem solving, divorce, poor residential father relationship, sexual relationships, and delinquent behaviors did not predict depressive episodes in African American adolescents but did in European American. Low family and peer connectedness were important common vulnerability factors for both groups.

CONCLUSIONS

Differing patterns of vulnerability suggest that alternative strategies may be better suited to preventing depression among African American youth. A first step may lie in understanding what mediates the effect of low parental educational status on future depression risk.

Area deprivation affects behavioral problems of young adolescents in mixed urban and rural areas: the TRAILS study

PURPOSE

Behavioral problems occur more frequently among adolescents in deprived areas, but most evidence concerns urbanized areas. Our aim was to assess the impact of area deprivation and urbanization on the occurrence and development of behavioral problems among adolescents in a mixed urban and rural area and to examine the contributory factors.

METHODS

We obtained data from the first two waves (n=2,230; mean ages, 11.5 and 13.5 years respectively; response at follow-up, 96.4%) of the TRacking Adolescents' Individual Lives Survey (TRAILS). TRAILS is a prospective study of adolescent mental health in a mixed urban and rural region of the Netherlands. We assessed adolescent behavioral problems using the parent-reported Child Behavior Checklist (CBCL), the adolescent-reported Youth Self-Report (YSR) and the Antisocial Behavior Scale (ABS). Living areas were categorized into tertiles of deprivation. We further collected data on child temperament, perceived rearing style, parental socioeconomic position (education, income and occupation), family composition, and parental mental health history.

RESULTS

At baseline, adolescents living in the most deprived tertile more frequently had elevated behavioral problem scores than those from the least deprived tertile on the CBCL (11.2% against 7.1%), YSR (11.9% against 6.9%), and ASB (11.5% against 7.4%) (all p < .05). Socioeconomic position explained half of the differences due to area deprivation. Other familial and parental characteristics did not significantly contribute to the explanation of observed area differences.

CONCLUSIONS

As in highly urbanized areas, behavioral problems occur more frequently among adolescents in deprived mixed rural and urban areas. Urbanization has little effect on these area differences.

Adult household smoking is associated with increased child emotional and behavioral problems

CONTEXT

Although maternal smoking has been associated with child emotional and behavioral problems, to our knowledge, no study has evaluated the association between overall household smoking and such problems.

OBJECTIVES

To investigate whether children who live with smokers are more likely than children who do not live with smokers to have emotional or behavioral problems and to explore this association in households with nonsmoking mothers.

DESIGN, SETTING, AND PARTICIPANTS

Nationally representative data from the 2000 to 2004 medical expenditure panel surveys, involving 30,668 children aged 5 to 17 years, were used. Associations between child emotional or behavioral problems and household smoking, and child, maternal, and family characteristics were examined. SUDAAN software was used to adjust for complex sampling design.

MAIN OUTCOME MEASURES

Overall score on the Columbia Impairment Scale, a 13-item parent-report measure of child emotional or behavioral functioning (range, 0-52, >or=16 indicates a child with such problems).

RESULTS

Children in smoking versus nonsmoking households were significantly more likely to have behavioral problems (17.39% vs 9.29%, p < .001). After adjusting for all covariates, male sex, older age of child, younger age of mother, unmarried mother, maternal depression, and below average maternal physical and mental health, each were independently associated with increased likelihood of emotional and behavioral problems, as was the presence of one or more adult smokers in the household (adjusted odds ratio 1.42; 95% confidence interval: 1.26-1.60). The odds of Columbia Impairment Scale score >or=16 increased with increasing number of smokers in the household, even among children whose mothers did not smoke.

CONCLUSION

Children living with smokers are at increased risk for emotional or behavioral problems, and rates of such problems increase with increasing numbers of smokers in the household, even in the absence of maternal smoking.

Community-based perinatal depression services for African American women: the healthy start model

A variety of factors place African American women at risk for depression. Unfortunately, a behavioral health system insensitive to these women's needs exacerbates their risk. Recent reports recommended that mental health services be accessible and acceptable to women of color and include comprehensive, culturally appropriate case management. The federal Healthy Start Initiative, a national maternal and child health program to reduce infant mortality and low birth weight, is an often-overlooked resource for responding to perinatal depression among African American women. Pittsburgh/Allegheny and Fayette County Healthy Start, Inc., offers a case example of the Healthy Start model to address depression.

Maternal literacy and associations between education and the cognitive home environment in low-income families

OBJECTIVE

To determine whether maternal literacy level accounts for associations between educational level and the cognitive home environment in low-income families.

DESIGN

Analysis of 369 mother-infant dyads participating in a long-term study related to early child development.

SETTING

Urban public hospital.

PARTICIPANTS

Low-income mothers of 6-month-old infants.

MAIN EXPOSURE

Maternal literacy level was assessed using the Woodcock-Johnson III/Bateria III Woodcock-Munoz Tests of Achievement, Letter-Word Identification Test. Maternal educational level was assessed by determining the last grade that had been completed by the mother.

MAIN OUTCOME MEASURE

The cognitive home environment (provision of learning materials, verbal responsivity, teaching, and shared reading) was assessed using StimQ, an office-based interview measure.

RESULTS

In unadjusted analyses, a maternal literacy level of ninth grade or higher was associated with increases in scores for the overall StimQ and each of 4 subscales, whereas a maternal educational level of ninth grade or higher was associated with increases in scores for the overall StimQ and 3 of 4 subscales. In simultaneous multiple linear regression models including both literacy and educational levels, literacy continued to be associated with scores for the overall StimQ (adjusted mean difference, 3.7; 95% confidence interval, 1.7-5.7) and all subscales except teaching, whereas maternal educational level was no longer significantly associated with scores for the StimQ (1.8; 0.5-4.0) or any of its subscales.

CONCLUSIONS

Literacy level may be a more specific indicator of risk than educational level in low-income families. Studies of low-income families should include direct measures of literacy. Pediatricians should develop strategies to identify mothers with low literacy levels and promote parenting behaviors to foster cognitive development in these at-risk families.

Effects of a conditional cash transfer program on children's behavior problems

OBJECTIVES

Governments are increasingly using conditional cash transfer programs to reduce the negative effects of poverty on children's development. These programs have demonstrated benefits for children's nutrition and physical development, but the effect of conditional cash transfers on children's behaviors has not been systematically evaluated. The objective of this study was to evaluate the effects of a conditional cash transfer on children's behavior by using a quasi-experimental design.

METHODS

In 1997, the Mexican government initiated a large-scale conditional cash transfer (Oportunidades) in 506 very poor rural communities. Oportunidades provided cash transfers that were contingent on visits to medical practitioners, consumption of nutritional supplementation, and school enrollment. In 2003, an assessment of 4- to 6-year-old children in these households was conducted, and outcomes were compared with children from 152 additional poor rural communities who had been recruited by using rigorous matching procedures. The primary outcome measure for this analysis was maternal report of behavior problems in terms of anxiety/depressive and aggressive/oppositional symptoms. Analyses reported here compared 778 children from beneficiary households who had received 3.5 to 5.0 years of exposure to the program and a comparison group of 263 children who had received no exposure to the program at the time of assessment but whose families later enrolled in the program.

RESULTS

Participation in Oportunidades was associated with a 10% decrement in aggressive/oppositional symptoms but was not associated with significant decrements in anxiety/depressive symptoms or total problem behaviors while controlling for covariates. Effects of treatment did not differ by children's gender or ethnicity.

CONCLUSIONS

Although this large-scale conditional cash transfer program for poor Mexican families did not directly address children's behavior problems, it found evidence of indirect effects on children's behavior. Results suggest that interventions that focus on investing in basic human capital needs may exert longer term ripple effects on children's development.