Parent perceptions and parent-child interactions in clinic-referred children: a preliminary investigation of the effects of maternal depressive moods

Psychosocial Intervention for Youth With High Externalizing Behaviors and Aggression Is Associated With Improvement in Impulsivity and Brain Gray Matter Volume Changes

Background: Stop, Now And Plan (SNAP) is a cognitive behavioral-based psychosocial intervention that has a strong evidence base for treating youth with high aggression and externalizing behaviors, many of whom have disruptive behavior disorders. In a pre-post design, we tested whether SNAP could improve externalizing behaviors, assessed by the parent-rated Child Behavior Checklist (CBCL) and also improve behavioral measures of impulsivity in children with high aggression and impulsivity. We then investigated whether any improvement in externalizing behavior or impulsivity was associated with gray matter volume (GMV) changes assessed using structural magnetic resonance imaging (sMRI). We also recruited typically developing youth who were assessed twice without undergoing the SNAP intervention. Methods: Ten children who were participating in SNAP treatment completed the entire study protocol. CBCL measures, behavioral measures of impulsivity, and sMRI scanning was conducted pre-SNAP and then 13 weeks later post-SNAP. Twelve healthy controls also completed the study; they were rated on the CBCL, performed the same behavioral measure of impulsivity, and underwent sMRI twice, separated by 13 weeks. They did not receive the SNAP intervention. Result: At baseline, SNAP participants had higher CBCL scores and performed worse on the impulsivity task compared with the healthy controls. At the second visit, SNAP participants still had higher scores on the CBCL compared with normally-developing controls, but their performance on the impulsivity task had improved to the point where their results were indistinguishable from the healthy controls. Structural magnetic resonance imaging in the SNAP participants further revealed that improvements in impulsivity were associated with GMV changes in the frontotemporal region. Conclusion: These results suggest that SNAP led to improvement in behavioral measures of impulsivity in a cohort of boys with high externalizing behavior. Improvement in impulsivity was also associated with increased GMV changes. The mechanism behind these brain changes is unknown but could relate to cognitive behavioral therapy and contingency management interventions, important components of SNAP, that target frontotemporal brain regions. Clinically, this study offers new evidence for the potential targeting of brain regions by non-invasive modalities, such as repetitive transcranial magnetic stimulation, to improve externalizing behavior and impulsivity.

Depressive symptoms and developmental change in mothers' emotion scaffolding: Links to children's self-regulation and academic readiness

This study examined whether the mechanism linking changes in Mexican-origin adolescent mothers' depressive symptoms to children's subsequent self-regulation and academic readiness was via their emotion scaffolding when their children were 2, 3, 4, and 5 years of age. Data included home interviews with adolescent mothers (N = 204), observations of mother-child interactions during a task that challenged children's abilities to manage their emotional arousal, and assessments of children's performance on measures of self-regulation and academic readiness. Adolescent mothers' higher depressive symptoms at child age 2 years were associated with a greater decline in mothers' emotion scaffolding from child age 2 to 5 years, which was subsequently linked to children's lower self-regulation and academic readiness at age 5. Possible implications from this line of work for adolescent mothers and their children are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Maternal Depression: Relationship to Food Insecurity and Preschooler Fruit/Vegetable Consumption

Background: Maternal Depression (MD) has been implicated in the etiology of obesity. The present study investigated MD and both child fruit/vegetable consumption (FVC) and household food insecurity (FI) in an early childhood population. Methods: This cross-sectional study was conducted in Arkansas, United States, in 26 Head Start centers. Teachers obtained the Family Map (FM), an interview assessment tool used by Head Start staff to identify potential risk factors that affect child learning and development. The FM contains a two-item screener of parent depression-the Patient Health Questionaire-2, two questions about family FI, and two questions about FVC. The FM was completed in 693 households. Chi square analyses and logistic regressions utilizing adjusted and unadjusted odds ratios were utilized to compare differences in risk for children of mothers with no symptoms compared to mothers with low- or high-level depressive symptoms. Results: Children whose mothers had high MD were 2.90 (CI: 1.21-7.00) and 7.81 (CI: 3.71-16.45) times more likely to be at risk for low FVC and FI, respectively, compared to children of mothers with no MD. Similar findings but at lower magnitude were found for mothers with low symptoms of MD in comparison with mothers with no MD-both for Low FVC (1.57 times more likely; CI: 1.01-2.45) and FI (2.14 times more likely; CI: 1.28-3.58). The results presented are Odds Ratios from the multivariable adjusted models. Conclusions: Implications for the etiology of obesity, prevention/intervention efforts, and future research are offered, including recommended addition of maternal depression and household FI screening in early childhood programs.

Maternal Depressive Symptoms and Perceived Picky Eating in a Low-Income, Primarily Hispanic Sample

OBJECTIVE

Feeding concerns are common in the first 2 years of life and typically reflect maternal perceptions occurring within the larger context of the parent-child relationship. We aimed to determine whether (1) maternal depressive systems predicted perceived picky eating, mediated by maternal negative perceptions; (2) receipt of the Video Interaction Project (VIP) parenting intervention impacted perceived picky eating through this pathway; and (3) perceived picky eating was associated with child growth or subsequent dietary patterns.

METHODS

We performed a partial longitudinal analysis of 187 low-income, predominantly Hispanic mother-child dyads enrolled in a randomized controlled trial of the VIP. Mother-infant dyads were enrolled postpartum in an urban public hospital. Participants randomized to the VIP met with an interventionist on days of well-child visits; sessions were designed to facilitate interactions in play and shared reading through provision of learning materials and review of videotaped parent-child interaction; the curriculum did not contain feeding-specific elements. We used structural equation modeling to determine direct, indirect, and total effects of maternal depressive symptoms, maternal negative perceptions, and the VIP on perceived picky eating. We then tested associations between perceived picky eating and (1) child growth, using multivariable linear regression and multilevel modeling; and (2) subsequent child dietary consumption, using multivariable multinomial logistic regression.

RESULTS

Maternal depressive symptoms had significant total effects on negative maternal perceptions (β = 0.32, p < 0.001) and perceived picky eating (β = 0.21, p < 0.01) after controlling for potential confounders. This effect was partially mediated by maternal negative perceptions (indirect effect: β = 0.06, p = 0.04). When used in the model as the predictor, the VIP had a significant total effect on perceived picky eating (β = -0.16, p = 0.02), which was partially mediated by maternal depressive symptoms and negative perceptions (indirect effect: β = -0.05, p = 0.02). Perceived picky eating was not associated with child diet at age 2 years or adiposity from 6 months to 3 years.

CONCLUSION

Maternal concerns about picky eating may reflect deeper depressive symptoms and negative perceptions of her child's behavior. Interventions designed to facilitate positive parenting in general may lessen feeding-specific concerns, such as picky eating. Although reassurance about growth and nutritional outcomes for children perceived as picky eaters is appropriate, clinicians should also consider probing for underlying symptoms of depression that could lead to eating concerns.

Depression alters maternal extended amygdala response and functional connectivity during distress signals in attachment relationship

Maternal attachment-related parenting behaviors require mothers to regulate self-related and child-related distress. Emotion regulation is, in turn, influenced by maternal mood and personal developmental history. In the current study we examined how depressive mood may alter maternal limbic system function and functional connectivity underlying defensive and hedonic motivations. Twenty nine mothers were recruited to undergo a baby-cry task during a functional magnetic resonance imaging (fMRI) scan. Based on self-reported depression symptoms and clinical interview, the participants were grouped as healthy controls (n=15) and currently depressed (n=14). In the baby-cry task, 30s-long auditory stimuli of baby-cry sounds were presented to simulate four conditions: generic baby-cry (Just-Listen), baby-cry as if it were their own child's cry (Your-Baby), baby-cry as if it were themselves (Self), and matched control sounds (Noise). Depressed mothers, as compared to healthy controls, showed greater Self versus Just-Listen responses in left extended amygdala and decreased functional coupling between this left extended amygdala as the seed and nucleus accumbens (NAc) in self-oriented (Self versus Just-Listen) and child-oriented (Your-Baby versus Just-Listen) distress signals. Moreover, the extended amygdala's differential functional connectivity with dorsomedial prefrontal cortex (dmPFC) during the Your-Baby versus Self was increased for depressed mothers and decreased for healthy controls. Thus, depression may affect mothers by increasing baby-cry threat responses and dysregulating associations between threat and heathy child-oriented parenting motivations. These results are discussed in the context of attachment and self-psychology.

BEYOND THE DYAD: THE RELATIONSHIP BETWEEN PRESCHOOLERS' ATTACHMENT REPRESENTATIONS AND FAMILY TRIADIC INTERACTIONS

This study examines the relationship between triadic family interactions and preschoolers' attachment representations, or internal working models (IWMs), from a qualitative and dimensional perspective. Individual, relational, and sociocultural variables were evaluated using two different samples. The results showed that triadic family interactions were linked to preschoolers' attachment security levels in both groups, indicating the reliability of the proposed model.

Intergenerational Transmission of Internalizing Behavior: The Role of Maternal Psychopathology, Child Responsiveness and Maternal Attachment Style Insecurity

BACKGROUND

Maternal depression and anxiety disorders are risk factors for the development of internalizing disorders in offspring. Maternal attachment has been discussed as one factor accounting for transmission. The aim of this study was to investigate child internalizing behavior at preschool age on a symptomatic and behavioral level and possible links to maternal mental health over time and maternal attachment style insecurity in a sample of postpartum depressed and anxious mothers.

SAMPLING AND METHODS

Child internalizing behavior at preschool age was rated by the Child Behavior Checklist (CBCL), the Caregiver-Teacher Report Form (C-TRF), and during a mother-child free-play situation. We focused on child responsiveness as it has been linked to child internalizing behavior. Maternal attachment style insecurity was tested to mediate the link between maternal mental health (assessed postpartum and at preschool age with the Structured Clinical Interview for DSM-IV Axis-I Disorders, SCID-I) and child internalizing behavior/child responsiveness. Of the overall sample (n = 58), 28 women were diagnosed with postpartum depression and/or anxiety disorders according to DSM-IV, and 30 were healthy controls. Data were collected 3-9 months after delivery and at preschool age (mean = 4.6 years).

RESULTS

At preschool age, children of postpartum depressed and anxious mothers were rated significantly higher on child internalizing behavior by mothers, fathers, and additional caregivers compared to the control group. Child internalizing behavior rated by mothers was influenced by current psychiatric symptoms; maternal attachment style insecurity did not mediate this link. During interaction, children in the clinical group displayed significantly less child responsiveness compared to the control group. Maternal attachment style insecurity mediated the relationship between maternal mental health over time and child responsiveness.

CONCLUSIONS

The results emphasize the need for interventions focusing on mother-child interaction and maternal attachment.

Neural changes associated with treatment outcome in children with externalizing problems

BACKGROUND

The current study directly investigated whether changes in the neural correlates of self-regulation (SR) are associated with the effectiveness of treatment for the externalizing problems of children.

METHODS

Seventy-one children 8-12 years of age with clinical levels of externalizing behavior and their families completed a 3-month cognitive behavioral therapy program with a parent management training component. Electroencephalogram correlates of SR were evaluated before and after treatment with a go/no-go task requiring inhibitory control.

RESULTS

Results showed that neural markers of SR, such as the N2 and frontal P3 event-related potential magnitudes, differed between the clinical sample and a matched comparison group before treatment: the clinical sample had larger N2 magnitudes and smaller frontal P3 magnitudes. Children who improved with treatment demonstrated a marked decrease in the magnitude of the N2 in comparison with children who did not improve. For improvers only, source analyses during the time period of the N2 estimated activation decreases in medial and ventral prefrontal cortex as well as the anterior medial temporal lobe.

CONCLUSIONS

A decrease in N2 magnitudes and corresponding source activation in children who improved with treatment might reflect improved efficiency in the neural mechanisms of SR.

Maternal reports of child behavior problems and personal distress as predictors of dysfunctional parenting

A community sample of 96 mother-child dyads participated in a study evaluating the extent to which directly observed differences in maternal parenting behavior could be predicted on the basis of both global and proximal maternal reports of child behavior problems and personal distress. To allow for simultaneous testing of a set of relations and make tentative causal inferences, a structural equation modeling approach was used. When the analysis was conducted on the entire sample, results indicated that global and to a lesser extent proximal measures of child behavior problems and personal distress made modest contributions to dysfunctional parenting, with neither child behavior problems or personal distress playing a more important role than the other. When the sample was divided into low (n = 54) and high (n = 42) socioeconomic disadvantage (SED) families, a different picture emerged. In low disadvantage families, parenting was most strongly predicted by mothers' proximal reports of their children's behavior; whereas in high disadvantage families, parenting was best predicted by mothers' proximal reports of their own personal distress. Results are interpreted in light of Wahler and Dumas' (1989) attentional hypothesis. It suggests that mothers who do not experience chronic sources of distress (such as SED) attend and respond to their children's behavior in a fairl accurate and consistent manner, but that mothers who experience chronic distress are unable to attend effectively to their children, responding to them often in light of the many stressors to which they are exposed, rather than in light of the children's actual behavior.

Depressed Mood and Maternal Report of Child Behavior Problems: Another Look at the Depression-Distortion Hypothesis

Caregiver depression has been described as leading to overreport of child behavior problems. This study examines this "depression-distortion" hypothesis in terms of high-risk families of young adolescents. Questionnaire and diagnostic interview data were collected from mothers, teachers, and fathers, and self-report information was obtained from youth between ages 10 and 14 years. First, convergent and discriminant validity were demonstrated for internalizing and externalizing multiagent constructs. Second, the depression-distortion hypothesis was examined, revealing a modest effect of maternal depression, leading to the inflation of reported son externalizing and daughter internalizing problems. The data suggest the need to consider multiple influences on parental perceptions of child behavior and psychopathology in research and clinical settings.

Psychological adjustment in young children with chronic medical conditions

Children with chronic medical conditions are at higher risk for behavioral and emotional problems compared to physically healthy children. This study used a conceptual model to examine factors associated with psychological adjustment in children aged 7-11 years old with any of four chronic illnesses. The variables most closely associated with child adjustment included the following: mothers' evaluation of the impact of the child's illness on the family; child's perceptions of parental acceptance; and child's self-perceptions of physical appearance, social acceptance, and athletic competence. These findings confirm the importance of maternal and child perceptions in understanding the psychological adjustment of children with chronic conditions.

Abusive parents' reports of child behavior problems: relationship to observed parent-child interactions

PURPOSE

We evaluated the hypothesis that abusive parents' reports may exaggerate rates of child behavior problems in a clinical sample.

METHOD

The association between parental ratings of behavior problems and independent observations of child behaviors was examined in a sample of 205 clinic-referred families, 58 of which had a reported history of physical abuse.

RESULTS

Relative to the comparison group, parents in the abuse group reported more externalizing problems in their children after controlling for parental psychopathology, and displayed more emotionally controlling and less supportive behavior during parent-child interactions. However, there was no association between abuse history and observed child behaviors during the interaction tasks. Abuse status significantly moderated the association between parent-reported externalizing behaviors and observed demanding behavior by the child; the association was significant among comparison families, but not in the abuse group families.

CONCLUSIONS

Results indicate that abusive parents may over-report externalizing behavior problems in their children.

Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder

An adaptation of the Coping With Depression Course (CWDC) was evaluated in mothers of children with attention-deficit/hyperactivity disorder (ADHD), a population at risk for depression. Mothers were randomly assigned to receive the CWDC either immediately following an intensive summer treatment program targeting their child's behavior or after a wait-list period. Measures of maternal functioning, cognitions about child behavior, parent-child and marital relationship quality, child behavior, and ADHD-related family impairment were obtained at pretreatment, posttreatment, and 5-month follow-up. The CWDC resulted in improvements in maternal depressive symptoms, maternal self-esteem, child-related cognitions, and family impairment at posttreatment compared to a wait-list control group that were maintained at follow-up. Findings suggest that the CWDC is a promising intervention for mothers of children with ADHD, particularly those with current depressive symptomatology.

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.

Child behavior problems and maternal symptoms of depression: a mediational model

PROBLEM

The relationship between maternal depression and child behavior problems has been consistently demonstrated, but not the impact of child behavior problems on maternal depression.

METHODS

Mothers of 3- to 6-year-old children (N=69) reported regarding their depression, parenting competence, attachment to the child, the child's impact on the family, and behavior problems.

FINDINGS

Child behavior problems were positively associated with maternal depression, an association explained by mediating variables: impact of the child on the family, mother's parenting competence, and attachment to the child.

CONCLUSIONS

Maternal depression should be considered when providing clinical services to children, given the potential for exacerbation of symptoms in the face of child behavior problems.

Retrospective reports of college students' childhood problems

College students and a subsample of their mothers and fathers participated in a study examining their retrospective reports of childhood emotional and behavioral problems experienced by college students. College students and their mothers and fathers exhibited moderate correspondence in their recollection of internalizing and externalizing problems that college students experienced during their childhood. In contrast, college students tended to endorse significantly greater levels of both internalizing and externalizing problems relative to their mothers and fathers. Current psychological symptoms predicted the greater endorsement of childhood internalizing and externalizing problems by college students and the greater endorsement of college students' childhood internalizing problems by their mothers. Further, college students' current perceptions of their parents predicted their endorsement of childhood internalizing problems, and college students' current masculinity and femininity predicted their endorsement of childhood externalizing problems. Results of this study emphasized the importance of noting factors that may be related to retrospective reports.

Affective disorders

Unipolar depressive disorders are especially common among persons presenting with marital and family problems, rendering their impact on the treatment of marital and family problems of interest to every marriage and family therapist. The current paper describes empirically based decision making rules for determining who may benefit most from marital and family therapy interventions. Using well-controlled outcome research, it is concluded that both marital therapy and parenting interventions can play an important role in the treatment of many but not all depressed persons. Predictors of treatment response are discussed and recent epidemiological research is used to examine the size of the population that may respond especially well to marital therapy. Future directions for research are suggested and public policy implications are discussed.

Expressed emotion, attributions and depression in mothers of children with problem behaviour

BACKGROUND

This was an initial study seeking to examine the relationship between Expressed Emotion (EE), spontaneous causal attributions and depression in mothers of children referred for problem behaviour.

METHOD

Sixty-one mothers were interviewed using the Camberwell Family Interview (CFI). The CFI was coded for maternal EE and spontaneous causal attributions regarding the child's behaviour. Self-report measures of child problem behaviour and maternal depressive symptoms were also completed.

RESULTS

Consistent with previous research, high EE mothers, compared to low EE mothers, were more likely to make attributions thatjudged the cause of problem behaviour to be personal to and controllable by the child and also made more 'child-blaming' attributions than low EE mothers. Mothers' scores on the Beck Depression Inventory were found to be associated with 'child-blaming' attributions and higher levels of EE. Regression analyses did not support the hypothesised role of attributions as a mediator between depression and EE but did identify EE as a potential mediator in the relationship between maternal depressed mood and ratings of child problem behaviour.

CONCLUSIONS

These results indicate the relevance of both EE and attributions in mothers of children with problem behaviour and suggest that maternal depressed mood is an important factor which is related to both of these.

Revisiting the accuracy hypothesis in families of young children with conduct problems

Revisited the accuracy hypothesis in an examination of the relation between maternal depressive symptomatology and child conduct problems. All data were gathered as part of the pretreatment assessment in an outcome study of families with clinic-referred children with conduct problems (age 3 to 6). The mothers varied in their depressive symptomatology, from not at all symptomatic to severely symptomatic. Correlations indicated that with increasing depressive symptomatology, mothers (N = 97) displayed a higher rate of physical negative behaviors towards their child and reported more child conduct problems. Regression analyses revealed that at the lowest levels of maternal depressive symptomatology there was a discrepancy between mothers' reports of child behavior problems and child deviant behaviors observed during mother-child interaction. In contrast, at higher levels of depression, mothers' reports of child behavior were consistent with laboratory observations of their child's behavior. These findings provide evidence to support the accuracy hypothesis in reference to mothers who display a high degree of depressive symptomatology, but the results also call into question the validity of maternal report in families with children with conduct problems.

Maternal depression and parenting behavior: a meta-analytic review

The results of 46 observational studies were analyzed to assess the strength of the association between depression and parenting behavior and to identify variables that moderated the effects. The association between depression and parenting was manifest most strongly for negative maternal behavior and was evident to a somewhat lesser degree in disengagement from the child. The association between depression and positive maternal behavior was relatively weak, albeit significant. Effects for negative maternal behavior were moderated by timing of the depression: Current depression was associated with the largest effects. However, residual effects of prior depression were apparent for all behaviors. Socioeconomic status, child age, and methodological variables moderated the effects for positive behavior: Effects were strongest for studies of disadvantaged women and mothers of infants. Studies using diagnostic interviews and self-report measures yielded similar effects, suggesting that deficits are not specific to depressive disorder. Research is needed to identify factors that affect the magnitude of parenting deficits among women who are experiencing depression and other psychological difficulties.

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 influence of distress on mothers' and fathers' reports of childhood emotional and behavioral problems

This study examined the effect of parental distress on mothers' and fathers' reports of children's emotional and behavioral problems. The subjects were the parents of 696 children aged 10 to 11 or 14 to 15 years living in two-parent families in the community. The study utilized an extended version of the model previously employed by Fergusson, Lynskey, and Horwood (1993) to examine the impact of maternal depression on mothers' reports of children's behavior. In the present study, the extended model was used to assess the impact of distress on reports of childhood externalizing and internalizing problems obtained from both mothers and fathers. The results suggested that distress had little influence on mothers' or fathers' reports of childhood behavior problems. It is concluded that in community studies the size of any bias in mothers' and fathers' reports of childhood behavior problems due to parental distress is likely to be very small and of little clinical significance.

Mother-child agreement on self-report of anxiety in abused children

This study investigates the lack of agreement in maternal and child report of child anxiety with a sample of abused and nonabused clinic-referred children. Based on the literature, it was predicted that nonabused clinic-referred children would report more symptoms of anxiety than their mothers would report for them. It was also predicted that mothers of abused children would report greater anxiety symptoms for their children than the children's self-report. Finally, it was predicted that maternal psychopathology, specifically anxiety, would increase the probability that mothers would overreport their children's anxiety. Mother-child agreement based on anxiety symptoms assessed by the Quay Behavior Problem Checklist and the Revised-Children's Manifest Anxiety Scale was obtained on 54 male and female outpatients, 5 to 16 years of age. Overall, mothers reported significantly more anxiety for their children, than the children's own self-report, irrespective of abuse history. The implications of the findings are discussed with respect to the validity of maternal and child report. Directions for future research are also offered.

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.

Neurophysiological assessment of brain function and maturation: I. A measure of brain adaptation in high risk infants

Neurophysiologic assessments using EEG/polysomnographic studies permit the clinician to recognize expected patterns of brain maturation in the healthy neonate. By comparison, one can detect encephalopathic behaviors of newborns who are medically at risk. Severe physiologic expressions of encephalopathy are associated with neuropathologic lesions on postmortem examinations, brain lesions documented on neuroimaging studies, and major neurodevelopmental sequelae of survivors. However, such patterns are observed for only a minority of high risk neonates; less severe encephalopathies occur more frequently in neonates without evidence of brain lesions on imaging studies who either recover from medical illness or who manifest no findings of neurological dysfunction. These subtle and persistent brain disorders are obviously more difficult to detect and grade. This is specifically relevant for preterm infants in whom various degrees of encephalopathy may exist, but whose physiologic behaviors must be distinguished form expected behavioral and neurophysiologic patterns of prematurity. Neonates may express brain dysfunction as altered rates of brain maturation, as compared with expected patterns for a given conceptional age. Neurophysiologic expressions of brain dysmaturity, either from prenatal and/or postnatal stresses, may actually occur in a substantially larger segment of the high risk neonatal population than has been anticipated. EEG-sleep studies can serve as a noninvasive neurophysiologic probe of brain organization and maturation to extend clinical observations to assess the severity and persistence of brain dysfunction in a neonate who may be at risk for later neurodevelopmental compromise.

Determinants of physical activity in obese children assessed by accelerometer and self-report

Previous research has shown that predictors of activity in adults depend upon the method of measurement. This study is designed to assess the predictors of activity in a sample of 59 obese children. Activity was measured using self-reported and TriTrac accelerometer METs. Self-report and TriTrac accelerometer measures were moderately correlated, r = 0.46, with the self-reported activity (2.3 METs) significantly greater than TriTrac (1.6 METs). Hierarchical regression analysis examined the influence of socioeconomic level, body composition, fitness, hedonics of child and adult activity behaviors, and decisional balance on self-reported and accelerometer-measured activity, controlling for child and parent psychopathology. Child and parent psychological symptoms accounted for 8.3% and 3.4% of the variance in accelerometer and self-reported METs, respectively. The model for accelerometer-measured activity showed socioeconomic level and parent self-report of activity accounted for 14.8% of the incremental variance in child activity. The model for self-report of child activity found that child fitness accounted for 23.5% of the incremental variance in child activity. These results suggest that the predictors of activity level are different based upon the method of measurement, consistent with research in adults.

The association of maternal psychopathology and family socioeconomic status with psychological problems in obese children

In an earlier study we found parental psychiatric symptoms to be a better correlate of behavioral problems in obese children than either child or parental obesity. This study sought to extend this research by assessing the association of general maternal distress, specific maternal psychopathology, family socioeconomic status and child obesity with the psychological problems of 152 children seeking treatment for obesity in two cohorts. Child psychological problems were measured using the Child Behavior Checklist/4-18 (CBCL) in each cohort. In sample 1 maternal general psychiatric symptoms were measured using the Cornell Medical Index (psychiatric subscales) and the Inventory of Interpersonal Problems whereas specific psychopathology was assessed with the Beck Depression Inventory and the Bulimia Test. In sample 2 the Symptom Checklist-90 and Binge Eating Scale provided general and specific measures of psychopathology. In the combined sample, 58% percent of the boys and 44% of the girls met criteria on at least one CBCL behavioral problem scale, with Social Problems the most prevalent problem in both boys and girls. For both samples, child obesity did not account for any variance in child psychosocial problems beyond that accounted for by maternal psychopathology and family SES. Family SES accounted for a significant increment in variance in child behavioral problems in only two scales. This study systematically replicates previous research, adding support for a broader conceptualization of factors that influence psychological problems in obese treatment-seeking children than one which focuses on child obesity.

Personality and parenting: exploring the mediating role of transient mood and daily hassles

In order to explore the role that transient mood and daily hassles might play in mediating the impact of enduring personality on parenting, naturalistic home observations of mothering and fathering were conducted when firstborn sons were 15 and 21 months of age. Observationally based, behavioral ratings of mothering and fathering were related to three self-report personality scales (Agreeableness, Neuroticism, Extraversion), administered to parents when their children were 10 months of age, and to self-reports of transient mood (positive and negative) and daily hassles obtained prior to each observation of family interaction. Results indicated that (a) mothering was more consistently predicted by personality and mood/hassles than fathering; (b) Extraversion played a larger role in predicting fathering than mothering, with the reverse being true of Agreeableness; (c) Neuroticism was the most consistent predictor of men's and women's parenting; and (d) there was little support for affect-specific linkages between personality, mood/hassles, and parenting. Finally, some evidence of mediation by transient mood and daily hassles emerged, more consistently for mothers than fathers, though more strongly for fathers than mothers. These results are discussed in terms of the primacy of the role of parenting for men and women.

Parent-child agreement on ratings of anxiety in children

Research on congruence of parents' and children's reports of children's symptomatology has typically yielded low to moderate agreement. This study extended past research by examining the rate of parent-child agreement on reported anxiety for a nonclinical sample of children. 85 children ages 8 to 16 years and attending recreational summer camps completed measures of their own anxiety and parents completed the same scales on their children twice; once according to their perceptions of their own child's anxiety and once for how they predicted their own child would complete the measures. Analysis indicated that (a) parent-child correspondence was low when using either parents' perceptions or predictions of their child's anxiety, (b) mother-father correspondence on their child's anxiety was moderately high, (c) the children's gender and age were not significantly associated with correspondence, and (d) mothers' and fathers' anxiety was negatively associated with parent-child correspondence. The implications of these findings for research and clinical practice are discussed.

The stigma of mental illness on children of color

Children and adolescents who have been designated as mentally ill, mentally retarded, juvenile delinquent, poor, homeless, or sexually abused at some point in their lives experience a great deal of difficulty in removing such labels. Society has persisted in using these labels even when the designated person is engaged in many of the things taken for granted among "normal" persons of their age and culture. The author discusses the stigma that results from unreliable, invalid, unstandardized identification of psychiatric disorders, particularly among children from ethnic minority groups. Research is needed that improves clinical information processing, particularly among the multicultural population of the United States. For too long majority-based norms have been the focus of research, with little consideration given to the creative adaptations that have occurred among ethnic minority groups.

Emotional/behavioral problems in clinic and nonclinic children: correspondence among child, parent and teacher reports

This study examined the correspondence among child, parent and teacher reports, in rating emotional and behavioral problems of 98 community nonpatients and 64 clinically referred children (ages 6-13). The mean ratings differed significantly for the three sources and for the two samples, and there were a few significant interactions. Correlations of the scores between sources, especially parents and teachers, were in the moderate range and were not significantly different from one another. Informant correspondence was higher for externalizing than internalizing problems in both patient and nonpatient samples, and was higher for nonpatients than patients. In general, informant agreement was higher for cases characterized by lower family stress and higher child acceptance, among other clinical variables.

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.