Factors in the referral of children for behavioral treatment: a comparison of mothers of clinic-referred deviant, clinic-referred non-deviant and non-clinic children

The Role of Maternal Distress in a Parent Training Program to Modify Child Non-compliance

This paper reviews the effects of maternal distress on several aspects of parent—child interactions that were identified in the course of a parent training program for child non-compliance. Distress was measured by a number of self-report questionnaires examining depression, anxiety, marital relations, and extrafamilial relationships. The parent training program is initially reviewed. Subsequently, pretreatment relationships between maternal distress and parent—child interactions were examined. Distress appears to be related primarily to measures of parent perceptions of child maladjustment. Several relationships between distress and treatment outcome also were noted. A recent study designed to enhance parent training by modifying maternal distress factors is presented. Finally, implications and limitations of the data are discussed.

Evaluation of a Group Programme for Parents of Problem Children

A behaviourally based Programme was developed to assist parents with problem children. The Programme was intended for the typical social service clientele of single parent, low income or state benefit families and may be administered by social workers or assistants conversant with the Programme Manual. The Programme consists of six 90 min sessions run at weekly intervals during which a variety of behavioural techniques are taught, largely through role play, with a seventh follow up session a month later.

The Programme was evaluated by a range of before and after measures on both a treatment group and a waiting list control group and maintenance of treatment gains was tested at three and, for some measures, six months interval. The Programme significantly reduced: the perceived number and intensity of child behaviour problems; parental depression, inward irritability and outward irrirability; and the level of perceived chlid conduct problems, impulsivity and anxiety. It significantly improved parents' chlid management skills. Improvement in parental depression and irritability was maintained at three months and reduction in chlid beviour problems was tested for and found at both three and six months.

Infants of depressed mothers

Literature is reviewed demonstrating the impact of maternal depression on early infant interactions and development. Infants of depressed mothers (a) develop a depressed mood style as early as 3 months; (b) this mood generalizes to interactions with nondepressed women; (c) it persists over the first year if the mother's depression persists; and (d) it affects growth and Bayley developmental scores by the end of the first year. Other data are reviewed on individual differences including maternal depression styles of withdrawal and intrusion, negative behavior matching, and distorted perceptions of behavior. Finally, genetic, intrauterine, and extrauterine environment effects are discussed and interventions are suggested for altering the mother's depressed behavior and distorted perceptions. The review concludes that a developmental psychopathology perspective is needed to better understand the development of early depression.

[Prevalence and co-occurrence of five types of ill-treatment in relation with depression and conduct disorder in adolescent mothers]

In this article, the authors reflect on co-occurrence of different types of maltreatment that adolescent mothers have suffered during their childhood in order to better understand intergenerational transmission of maltreatment. They underline that studies on maltreatment that adults or adolescents have been subjected to during their childhood generally do not take into account co-occurrence of different types of maltreatment. The authors first attempt to verify if adolescent mothers are different from women of the general population in regards to prevalence and co-occurrence of various types of maltreatment suffered during their own development. They then try to establish prevalence and co-occurrence of types of maltreatment in relation to diagnoses of major depression or conduct disorder in adolescent mothers.

Predictors of parent training efficacy for child externalizing behavior problems--a meta-analytic review

BACKGROUND

The differential effectiveness of parent training has led researchers to examine a variety of child, parent, and familial variables that may predict treatment response. Studies have identified a diverse set of child, parent psychological/behavioral and demographic variables that are associated with treatment outcome and dropout.

METHOD

The parent training literature was examined to isolate child, parent, and family variables that predict response to parent training for child externalizing behavior problems. A literature review was conducted spanning articles published from 1980 to 2004 of indicated prevention (children with symptoms) and treatment (children with diagnosis) studies. Meta-analyses were conducted to determine standardized effect sizes associated with the identified predictors.

RESULTS

Many of the predictors of treatment response examined in this meta-analysis resulted in moderate standardized effect sizes when study results were subjected to meta-analytic procedures (i.e., low education/occupation, more severe child behavior problems pretreatment, maternal psychopathology). Only low family income resulted in a large standardized effect size. Predictors of drop-out resulted in standardized effect sizes in the small or insubstantial range.

CONCLUSIONS

Response to parent training is often influenced by variables not directly involving the child, with socioeconomic status and maternal mental health being particularly salient factors.

Enhancements to the behavioral parent training paradigm for families of children with ADHD: review and future directions

Behavioral parent training (BPT) is one of the empirically supported psychosocial treatments for ADHD. Over many years and in many studies, BPT has been documented to improve both child ADHD behavior and maladaptive parenting behavior. In some studies, BPT has also been found to result in benefits in additional domains, such as parenting stress and child classroom behavior. However, the BPT literature on children selected as having ADHD lags behind research conducted on BPT for children selected as having oppositional defiant and conduct disorders (ODD and CD, respectively) with regard to examination of factors that may limit treatment attainment, compliance, and outcomes, such as single parenthood, parental psychopathology, and child comorbidity. Because of the high degree of comorbidity between ADHD and ODD/CD, it is difficult to separate the two BPT literatures. The parameters of BPT (e.g.. format and setting), parent factors, and child factors that may contribute to treatment outcomes for families of children with ADHD are reviewed here and recommendations for future BPT research in the area of ADHD are made.

Personal adjustment and perceptions of grandchild behavior in custodial grandmothers

Examined parenting stress, depression, parenting satisfaction, and perceptions of child behavior in 35 custodial grandmothers seeking outpatient psychological services for their grandchildren ages 3 to 12. These clinic grandmothers reported significantly greater stress and depression, less parenting satisfaction, and more negative perceptions of their grandchildren's behavior than did 35 nonclinic custodial grandmothers. Also, similar to a comparison group of 35 clinic mothers and to the empirical literature on clinic parents, the clinic grandmothers' personal adjustment (i.e., stress and depression) was related significantly to their perceptions of their grandchildren's behavior. Thus, assessment of custodial grandmothers' adjustment, as well as grandchild behavior, in clinical settings appears warranted.

The Behavior Management Flow Chart: a component analysis of behavior management strategies

Representative published child behavior management research was reviewed. Based upon the review, a task analysis of child behavior management strategies was conducted. The Behavior Management Flow Chart is a flow chart of the task analysis that synthesizes the research into a cohesive unit and visually depicts actions that adults may be trained to use to manage misbehavior displayed by disruptive children. A discussion compares and contrasts the Behavior Management Flow Chart with Hanf-model behavior management programs, the appropriate unit of analysis is examined, and concerns regarding integrating a wide range of research variables into a unitary model are addressed.

Does psychiatric history bias mothers' reports? An application of a new analytic approach

OBJECTIVE

To evaluate whether mothers' psychiatric history biases reports of their children's behavior problems, mothers' and teachers' reports of children's behavior problems were compared using a recently developed statistical approach.

METHOD

Child Behavior Checklists and Teacher's Report Forms were completed by mothers and teachers, respectively, about 801 six-year-old children. Mother's history of major depression, anxiety disorders, and substance use disorder was assessed by using the National Institute of Mental Health Diagnostic Interview Schedule. Generalized estimating equations were used for data analysis.

RESULTS

According to both teachers and mothers, maternal history of major depression was associated with more internalizing problems; the association was significantly stronger when mothers were the informants. Mothers with history of any psychiatric disorder reported more externalizing problems in their children than expected, whereas teachers' reports of externalizing behaviors were unrelated to maternal psychiatric history. These findings could not be explained by variations in children's behaviors across settings.

CONCLUSION

The generalized estimating equation models enabled simultaneous examination of whether children of depressed mothers have excess behavior problems and whether depressed mothers overreport behavior problems in their children. The results indicate that children of depressed mothers have more internalizing problems. In addition, depressed mothers overstate and overgeneralize their offspring's behavior problems. This study broadens the concerns with reporting bias beyond maternal depression to include other psychiatric problems. The results emphasize the potential for bias in family history studies that rely on informants.

Maternal depressive symptoms and depressive symptoms in adolescents

The relationship between maternal depressive symptoms and rates of adolescent (15-16 years) depressive symptoms was studied in a birth cohort of 934 New Zealand children. There was a clear correlation between maternal depressive symptoms and subsequent depressive symptoms in adolescent females (r = .44) but no association (r = -.01) between maternal depressive symptoms and depressive symptoms in adolescent males. Subsequent analysis suggested that the correlation between maternal depression and depressive symptoms in adolescent females was largely explained by the associations of both measures with a series of social and contextual factors including social disadvantage, marital discord and family adversity. It is concluded that maternal depression is only associated with depression in adolescence insofar as maternal depression is associated with social disadvantage, marital discord or family adversity.

The effect of maternal depression on maternal ratings of child behavior

There have been continuing concerns about the extent to which maternal depression may influence maternal reports of child behavior. To examine this issue, a series of structural equation models of the relationships between maternal depression and errors in maternal reports of child behavior was proposed and tested. These models assumed that (a) maternal depression was unrelated to maternal reporting behavior; (b) maternal depression causally influenced maternal reporting accuracy; (c) maternal depression was correlated with reporting accuracy. These models were fitted to data on maternal depression and multiple-informant (mother, teacher, child) reports of conduct disorder and attention deficit behaviors for a birth cohort of 12- and 13-year-old New Zealand children. The results of model fitting suggested the presence of small to moderate correlations (r = +.13 to +.40) between maternal depression and maternal reporting errors, indicating the presence of a tendency for increasing maternal depression to be associated with a tendency for mothers to over-report child behavior problems. However, independently of any effects of maternal depression on maternal reporting errors there was evidence of small but significant associations (r = .10 to .17; p < .05) between maternal depression and child conduct disorder and attention deficit behaviors.

The effect of maternal depression on maternal ratings of child behavior

There have been continuing concerns about the extent to which maternal depression may influence maternal reports of child behavior. To examine this issue, a series of structural equation models of the relationships between maternal depression and errors in maternal reports of child behavior was proposed and tested. These models assumed that (a) maternal depression was unrelated to maternal reporting behavior; (b) maternal depression causally influenced maternal reporting accuracy; (c) maternal depression was correlated with reporting accuracy. These models were fitted to data on maternal depression and multiple-informant (mother, teacher, child) reports of conduct disorder and attention deficit behaviors for a birth cohort of 12- and 13-year-old New Zealand children. The results of model fitting suggested the presence of small to moderate correlations (r = +.13 to +.40) between maternal depression and maternal reporting errors, indicating the presence of a tendency for increasing maternal depression to be associated with a tendency for mothers to over-report child behavior problems. However, independently of any effects of maternal depression on maternal reporting errors there was evidence of small but significant associations (r = .10 to .17; p < .05) between maternal depression and child conduct disorder and attention deficit behaviors.

Pathways to maladaptive parenting with mothers and their conduct disordered children

Maladaptive parenting with conduct disordered children appears to involve two social interaction traps called compliance and inconsistency. A mother's participation in these traps is thought to be influenced by her child, by the quality of the mother's life, and by her perceptions of child behavior. This study was an attempt to assess these influences and to examine their correlations with maternal trap participation. To do so, 33 clinic-referred conduct disordered children and their mothers were evaluated through direct observation, maternal self-reports, and maternal observations of home videotapes depicting mother and child. The data were then analyzed as correlational paths among trap measures and measures of the suspected influences. Results showed the two traps to be distinctly different processes, and inconsistency appeared to represent a more complex process than did compliance. Discussion of the findings centered on problems in maternal care of conduct disordered children and prospects for clinical interventions with these mother-child dyads.

Behavioural problems in children with Down's syndrome and their siblings

Reports of problem behaviour in children with Down's syndrome and their siblings were gathered from mothers, fathers and teachers. Twenty-one sibling pairs were included in the study. The Revised Behavior Problem Checklist (Quay & Peterson, 1983) was used to gather information on total problem behaviour and on five specific problem areas. Children with Down's syndrome were reported to display more problem behaviours overall and to show significantly more attentional problems than their siblings by all rater groups. Sisters of children with Down's syndrome were reported to be more conduct disordered than were brothers by mothers, fathers and teachers. Measures of depression and marital satisfaction found both parent groups to be in the non-distressed range on these instruments. Depression contributed significantly to both parents' reports of problems in the siblings while marital satisfaction was important for mothers' reports of problems in children with Down's syndrome.

Maternal depression: effects on social cognition and behavior in parent-child interactions

The social interactions of depressed and nondepressed mothers and their preschool-age children were observed and mothers' perceptions of child behavior assessed. Depressed mothers, as a group, exhibited more negative behavior than controls; however, no differences were found for maternal positive behavior or contingent responding. There was a high degree of reciprocity between child and mother behavior in both groups and there was a trend for children of the depressed mothers to be more negative than the control children. The results with cognitive measures were consistent with depressive realism in perception of social interactions: Depressed mothers recalled more negative child behavior than nondepressed mothers; however, these perceptions paralleled the observed interactions. Overall, the results suggest that maternal depression is associated with negative parent-child interactions and more negative, albeit fairly accurate, perceptions of child behavior.

Assessment-derived treatment of children's disruptive behavior disorders

The objective of assessment-derived treatment is to formulate therapeutic interventions that are based upon an identification of the variables that control the occurrence of clinical disorders. This article presents a discussion of several concerns related to the process of assessment-derived treatment of children's disruptive behavior disorders (attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder). The use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), diagnostic interviewing, behavior checklists, and direct observational methodologies for purposes of conducting a functional behavioral analysis is reviewed. The role of family variables and academic curriculum also are considered as components of a comprehensive assessment focus. A decision format that indicates the selection of therapeutic strategies as a function of identified controlling relationships is presented.

The influence of parenting stress and child behavior problems on parental estimates of expressive and receptive language development

This study examined the relative contributions of parental reports of child-related and parent-related stress to their estimates of expressive and receptive language skills on the Minnesota Child Development Inventory in 152 children referred to a communicative disorders clinic. Correlational analysis showed moderately high agreement between parental estimates and objective measures of expressive and receptive language ability. Multiple-regression analyses revealed that independent measures of language acquisition accounted for the greatest amount of variance in parental estimates of expressive and receptive language skills. Stressful child behavior accounted for a small but statistically significant proportion of the variance in estimates of expressive and receptive language skills. Parental stress, in contrast, did not contribute significantly to language estimates. These findings suggest that parents are able to formulate estimates of language development which are relatively independent of personal or child-related stressors.

Children at risk: II. Risk factors and clinic utilization

Using a strategy involving multiple raters and instruments, the authors compared 134 clinic subjects with controls matched on sex, age, and socioeconomic status to determine how various risk factors are related to clinic utilization apart from their effects on children's symptomatology. Parental psychopathology, family size, and marital status were most predictive of children's symptom levels, while stress levels, family size, and marital status were most predictive of clinic utilization. Although children's total symptom levels explained 27.6% of the variance in clinic utilization, other factors (family size, family history of divorce, stress, and parental psychopathology) explained an additional 13.2% of the variance. Findings indicate that clinicians and health care planners must carefully assess variables other than children's symptom levels in order to better understand children's mental health services utilization, develop more robust models of risk, and increase the effectiveness of our efforts directed towards prevention and intervention.

Children at risk: I. Risk factors and child symptomatology

The authors compared 134 6- to 12-year-old children from a military psychiatric clinic with a control sample to determine the salience of various risk factors in predicting levels of child psychopathology. Parents provided demographic information and completed standardized questionnaires on themselves and their children, while children completed two self-report symptom inventories. Results indicated that all hypothesized risk factors mediated effects on child psychopathology, but the effects of various risk factors differed as a function of the rater and type of psychopathological construct being measured. Generally, parental psychopathology and life stress mediated the greatest effects on overall child symptoms levels. Furthermore, the clinical and community samples differed in the presence and extent of risk factors. Results indicate the need for caution in studies of child psychopathology using only clinical samples and may suggest the importance of therapies based on environmental manipulations for a substantial proportion of patients seeking child psychiatric assistance.

Depressed mothers as informants in family history research--are they accurate?

A sample of 333 mother-child dyads was used to examine the association between major depression in mothers and children's symptoms. Findings based on children's self-reports were compared to findings based on mothers' reports about the children. Children's data support a depression-specific transmission. In contrast, mothers' data show an increased risk for all psychiatric syndromes covered in the study (including depression, anxiety, oppositionalism, inattention, hyperactivity, impulsivity, and antisocial acts). Results from multivariate analysis support the hypothesis that the discrepancy between mothers and children is in part a function of the tendency of depressed mothers to view their children as more symptomatic. The use of probands as informants may lead to an overestimation of familial aggregation, if the affected probands suffer from major depression or depressive symptoms.

Maternal depression and its relationship to life stress, perceptions of child behavior problems, parenting behaviors, and child conduct problems

This study examined the relationship of reported maternal depression to prior and current life stressors, and to mother perceptions of child adjustment, parenting behaviors, and child conduct problems. Forty-six depressed mothers and 49 nondepressed mothers and their clinic-referred children (aged 3-8 years) participated. Depressed mothers were more critical than nondepressed mothers, but the behavior of children of depressed and nondepressed mothers showed no significant differences. Depressed mothers were more likely to have experience child abuse, spouse abuse, or more negative life events than nondepressed mothers. Maternal reports of stress related to mother characteristics and to negative life events were the most potent variables discriminating depressed from nondepressed mother families.

Psychological and behavioral correlates of family violence in child witnesses and victims

Abused and nonabused child witnesses to parental violence temporarily residing in a battered women's shelter were compared to children from a similar economic background on measures of self-esteem, anxiety, depression, and behavior problems, using mothers' and self-reports. Results indicated significantly more distress in the abused-witness children than in the comparison group, with nonabused witness children's scores falling between the two. Age of child and types of violence were mediating factors. Implications of the findings are discussed.

Children and mothers at clinics: who is disturbed?

One hundred and eighty one white children aged 6 to 11 years who were attending medical outpatient clinics with their mothers were studied to assess the prevalence of psychological disturbance in the children, and anxiety and depression in the mothers. Teachers were also asked to assess the children independently using the Rutter scales. Mothers assessed 70 (39%) of the children as being disturbed, 20 of whom were also assessed as being disturbed by their teachers. A further 15 children were assessed as being disturbed by their teachers but not by their mothers. Thirty five (19%) of the mothers assessed themselves as anxious and two as depressed using the hospital anxiety and depression scale. Anxious and depressed mothers were significantly more likely to assess their child as being disturbed. In contrast, the teachers' assessments of the children were not affected by the mental state of the mothers. These findings confirm that mothers' perceptions of their children are modified by their own moods.

Normal and affectively ill mothers' beliefs about their children

Normal, unipolar, and bipolar depressed women were studied to determine whether depressive cognitive schemas extend to the perception of one's own child. Depressed and well mothers reported equal satisfaction with their children, but the depressed group was less satisfied with the children's socioaffective than their cognitive development. The depressed mothers experienced a greater degree of helplessness regarding their children, and were more likely to feel that outcomes of child development were determined by uncontrollable factors.

Positive interaction between mothers and conduct-problem children: is there training for harmony as well as fighting?

Child behavior therapists have concentrated largely on the study of family conflict in conduct-problem children. Positive interactions, such as play and conversation, and the impact these might have on problem behavior have been neglected in theoretical work, although some therapists (e.g., Sanders & Dadds, 1982) have paid attention to alternative family activities. In this study a sample of preschool conduct-problem children not only fought more with their mothers but also were quite deficient in all kinds of positive activities, compared to their normal counterparts. This result supports the notion that young conduct-problem children may be missing out on certain forms of harmonious experience with their mothers, which might otherwise help to prevent conflict. It is argued that the quality of these positive processes, like the better-known coercive ones (Patterson, 1982), demands further study, to broaden our theories and therapies for conduct problems.

Assessing the influence of maternal depression on the validity of the Child Behavior Checklist

The relative effects of maternal depression, child gender, and child psychiatric status on mothers' ratings of their children were assessed in a study of the validity of the Child Behavior Checklist (CBCL). Both maternal depression and gender were found to be significantly associated with mothers' ratings of their children on the CBCL. Nevertheless, mothers' ratings continued to differentiate groups of children with and without psychiatric problems even after the variance accounted for by maternal depression and child gender was removed. These findings support the criterion validity of the CBCL, and point also to the importance of assessing parents as part of the clinical evaluation of children.

Parental characteristics and interactional dysfunction in families with child behavior problems: a preliminary investigation

Thirty-six families with a preteenage behavior problem child were assessed on measures of marital discord, parental psychopathology, and three parental cognitive factors: knowledge of behavioral principles, tolerance for child deviancy, and expectations regarding their child's behavior. Nine nonproblem families with demographic characteristics similar to the problem families were also assessed. Correlational analyses across all families revealed a strong association between marital discord and the parental index of child behavior problems. While a number of significant associations were discovered between the various measures of marital discord, parental psychopathology, and parental cognitive factors, no other measure besides marital discord was associated with parental perception of child behavior problems. The nonproblem families and 15 of the problem families also participated in home observations obtained through random audio recordings during high interaction periods. These observational data indicated a significant relationship between parental perception of child behavior problems and parental negative behavior toward the child, but no significant relationship between parental perception of child behavior problems and child behavior, even when child behavior was weighted by parents' reactions to that behavior. Through sequential analysis, several contingent relations between parent and child behavior were discovered. Findings are discussed in relation to family systems theory.