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Child-focused behavioral assessment and modification.

Argues that behavioral principles have been translated into practice with children too literally and that a more integrative framework is required to guide assessment and treatment. The framework advocated is Staats's (1996) psychological behaviorism. This is a consistently behavioristic, positivist paradigm, using multilevel theory to emphasize the integration of social learning, developmental, and personality principles. Psychological behaviorism thus allows for a much more expansive approach than has typically been the case within child behavior therapy. Given the complexity of this perspective, I selected four broad tenets of the theory and suggested their implications for clinical contexts. The further translation from clinical models to specific clinical practices is quite difficult but may yield more flexible and substitutable practices than do unidimensional treatment outcome studies. Of special importance, the principles demonstrate how children themselves can retain the central focus of child behavioral assessment and modification. Specific practices still need to be constructed according to an understanding of the multiple sources of influence on children as well as the culture of childhood itself.

Behavior Therapy↗

A further assessment of predictors of the child's behavior in dental treatment.

The child's disruptiveness during dental treatment was related modestly to his age as well as his state, trait, and dental anxiety. In three samples comprising 132 experienced and 49 inexperienced pedodontic patients, the child's behavior during treatment could not be predicted from any aspect of maternal anxiety -- trait, state, or dental. Previous conceptions of maternal influence on the child's dental anxiety should be re-evaluated.

Anxiety↗

Using the language of the child's behavior in your work with families.

A child's behavior, and the way parents react to and understand that behavior, are important for professionals who work with families. Parental representations of a child's behavior provide an insight into their awareness of child development, as well as their thoughts, past experiences, values, and concerns. An appreciation of this parental viewpoint leads to a deeper and more effective professional relationship. In particular, when parents and professionals share their observations of a child's behavior and explore the meanings therein, they discover beneficial new ways of working together in support of the child and the family.

Adult↗

Parental influences on children's eating behavior and relative weight.

We investigated the relationship between selected parent behaviors, child mealtime behavior, and infant relative weight. Subjects were 7 male and 7 female children varying in age from 12 to 30 months (mean = 23.9 months). Each subject and parents were observed during the dinnertime meal on two occasions using the BATMAN (Bob and Tom's Method of Assessing Nutrition). The children spent 58% of the mealtime eating. They spent very little time making active decisions about what and how much they ate (food requests = 2% of the time; food refusals = 1% of the time). We found significant correlations between child relative weight and (a) parental prompts to eat (r = .81, p less than .001), (b) parental food offers (r = .51, p less than .05), and (c) parental encouragement to eat (r = .82, p less than .001). Thus, the present study suggests a relationship between certain parental variables and the relative weight of their children.

Body Weight↗

Mother-child interaction in autistic and nonautistic children: characteristics of maternal approach behaviors and child social responses.

The nature of mother-child interaction in autism and the maternal approach characteristics that elicit social response in children with autism were examined in two studies. Mother-child play sessions of 24 preschool children with autism and 24 typically developing preschoolers were compared in Study 1, and play sessions of 9 mothers with their autistic child and with their nonautistic child were compared in Study 2. Mother-child interactions were coded using the Approach Withdrawal Interaction Coding System to quantify maternal approach behaviors and child responses. Results of Study 1 indicate that, although the quantity of approaches did not differ between mothers with their autistic children and mothers with their nonautistic children, there were qualitative differences. Mothers used more physical contact, more high-intensity behaviors, and fewer social verbal approaches with autistic children. Results of Study 2 replicated these findings with mothers showing a similar pattern of approach toward their autistic children but not their nonautistic children. Although autistic children displayed lower contingency to maternal approaches in general, they showed greater responsiveness to approaches involving increased physical proximity and/or containing nonverbal object use. Mothers socially engaged both autistic and nonautistic children. The implications for parent training and intervention are discussed.

Adult↗

Behavior problems among young children in low-income urban day care centers.

The purposes of this study were to describe: (a) the frequency and correlates of behavior problems among a sample of 2- and 3-year-old children from low-income families as seen by their parents and day care teachers, (b) the degree to which parents and teachers agree about the children's behavior problems in their respective contexts, and (c) family characteristics that distinguish toddlers with behavior problems both at home and at day care from the rest of the sample. Parents of 133 toddlers from 10 Chicago day care centers completed measures of child behavior problems, child behavioral intensity, parenting self-efficacy, discipline strategies, and stress. Children's day care teachers also completed a measure of child behavior problems. Parent-reported behavior problems were associated with higher child behavioral intensity, greater parent stress, lower self-efficacy, and discipline strategies characterized by irritability, coercion, and inconsistency. Parent and teacher ratings on child behavior were correlated for boys' behavior problems only. Parents reported more child behavior problems than teachers. Approximately 8% of the children were rated as having behavior problems at home and at day care. Although most of the children are functioning well, many of these parents and toddlers are engaged in highly stressful and coercive relationships.

Chicago↗

Parent and child mealtime behavior in families of children with cystic fibrosis.

OBJECTIVES: We investigated the hypothesis that children with cystic fibrosis (CF) and their parents would show more maladaptive behaviors during dinner than children without CF and their parents. STUDY DESIGN: Children with CF (n = 32) and their parents were compared with 29 children without CF and their parents on the rate and frequency of parent-child behaviors during a typical dinner in the families' homes by using multivariate analyses of variance. RESULTS: When the rate of behavior, controlling for meal length, was examined, no differences were found between groups. However, parents of children with CF were found to differ from parents of control subjects in the frequency of direct and indirect commands (P <.05), coaxes (P <.01), physical prompts (P <.01), and feeding their child (P <.05). Children with CF were found to engage in more talk, spend more time away from the table, refuse food, and exhibit more noncompliance toward commands to eat than control children (P <.05 for all child variables). When behaviors were examined as a function of meal phase, parents of children with and without CF both showed an increase in commands (P <.01), coaxes (P <.05), feeds (P <.01), and physical prompts (P <.01) in the second half of the meal as compared with the first. Children with CF and the control children showed an increase in behaviors incompatible with eating during the second half of the meal compared with the first (P <.01). When faster eaters were compared with slower eaters, faster eaters consumed a higher percentage of the recommended daily allowance of energy (P <.01) than slower eaters and showed a trend to be at higher weight percentiles for age and sex (P =.08) regardless of group (CF or control). CONCLUSIONS: Children with CF and their parents do not differ from children without CF and their parents in the rate of behaviors exhibited or types of strategies used to encourage eating. However, children with CF and their parents engage in these behaviors more frequently. Our data do not support typical parenting behaviors as effective in meeting the CF dietary requirements. Additional support in the form of child behavior management training may be needed to assist parents in meeting their child's caloric requirements.

Adult↗

Emotional adaptation in children after liver transplantation.

The emotional adaptation of 25 children who had undergone successful liver transplantation at least 1 year previously was evaluated and compared with that of a control group of 26 children with diabetes mellitus, matched for age, gender, and socioeconomic status, and with reported normative values. With the use of parent- and self-report measures, emotional adaptation was assessed in terms of behavioral adjustment (Child Behavior Checklist), depressive experiences (Children's Depression Inventory), anxiety (State-Trait Anxiety Inventory for Children), and self-concept (Piers-Harris Children's Self-concept Scale). Similar variables were also assessed by a projective personality measure (Rorschach). We found minimal differences in emotional adjustment between liver transplant and diabetic groups; on self-report measures, the adjustment of those with liver transplants was as good as, or better than, that of normative samples. However, on other tests, children with transplants differed from normative samples. On projective measures, liver transplant recipients had an increased number of depressive experiences, situationally related internal distress, and a greater tendency toward negative self-focus and evaluation. We conclude that in pediatric liver transplant recipients, behavioral and emotional adjustment is as good as in children with another chronic illness; in comparison with physically well children, the transplant recipients have subtle signs of emotional difficulties.

Adaptation, Psychological↗

Parent behavior and child distress during urethral catheterization.

ISSUES AND PURPOSE: Researchers need a clear understanding of the natural behaviors parents use to help their children cope. This study describes the relationships between naturally occurring parent behaviors and child distress behaviors during urethral catheterization. DESIGN AND METHODS: In this descriptive study, researchers videotaped the behaviors of parent-child interactions during urethral catheterization. RESULTS: Parents used distraction to maintain calm behavior during the first part of the procedure and used more reassurance when the children started to become distressed. Seven of the nine children displayed calm behavior at least half the time following distraction. Parental reassurance did not decrease distress behavior in most children. PRACTICE IMPLICATIONS: Early implementation of developmentally appropriate nursing interventions to decrease child distress is imperative. Parents may need specific instruction and practice to continue the use of distraction throughout procedures, even when the child is upset.

Adaptation, Psychological↗

Influence of parents' eating behaviors and child feeding practices on children's weight status.

OBJECTIVE: To investigate the effects of mothers' and fathers' eating behaviors, child feeding practices, and BMI on percentage body fat and BMI in their children. RESEARCH METHODS AND PROCEDURES: Four hundred fifty-eight parents (239 mothers, 219 fathers) were asked to complete two questionnaires: the Three-Factor Eating Questionnaire and the Child Feeding Questionnaire, which measure dimensions of parent eating behavior and child feeding practices, respectively. Parent BMI was calculated from self-reported height and weight; children's measures included BMI and percentage fat assessed by DXA. Regression analyses were used to analyze relationships between parents' BMI and questionnaire scores and children's weight status. RESULTS: One hundred forty-three mothers and 68 fathers returned questionnaires, representing parents of 148 children 3 to 5 years old (78 boys). Children's weight was related to mothers' BMI, but not fathers'. Girls had a greater BMI if either parent reported being overweight as a child, and both girls and boys were likely to be overweight if their mothers believed they had risky eating habits (fussiness, eating too much, etc.). Girls with fathers who were more controlling had a higher percentage fat; these fathers were also more concerned about their daughters' future health. DISCUSSION: Mothers exert a strong influence over their children's weight and seem to be more concerned about their children's eating behaviors; however, fathers play a role in imposing child feeding practices. Gender bias may be present in child feeding, as suggested by dissimilar effects of parent practices on the weight status of girls vs. boys. Fathers should be included in future studies analyzing parent feeding practices and children's weight outcome.

Body Mass Index↗

Mothers' attributions for behavior in nonproblem boys, boys with attention deficit hyperactivity disorder, and boys with attention deficit hyperactivity disorder and oppositional defiant behavior.

This study compared attributions for child behavior among mothers of 38 nonproblem boys, 26 boys with attention deficit hyperactivity disorder (ADHD), and 25 boys with ADHD and oppositional defiant (OD) behavior. Boys ranged from 7 to 10 years of age. To capture different aspects of mothers' attributions, 2 assessment methods were employed: (a) ratings of the internality, controllability, globality, and stability of causes for written descriptions of child behavior and (b) coding of the types of causal attributions that mothers provided in vivo while watching their own child's behavior. In response to the written descriptions of child behavior, mothers of boys with ADHD/OD rated the causes of oppositional and inattentive-impulsive child behaviors as more stable and global than did mothers of nonproblem boys. In identifying causes of their own child's failure on lab tasks, mothers of boys with ADHD/OD provided more child-negative attributional causes than did mothers of either ADHD only or nonproblem boys. Implications for assessing and understanding attributions in families of children with ADHD and OD are discussed.

Adult↗

Attributions, affect, and behavior in abuse-risk mothers: a laboratory study.

OBJECTIVE: There were two main aims: first, to assess parental attributions about child behavior in abuse-risk and nonclinic parents. Second, to assess how attributions predict affective and behavioral reactions to child behavior. METHOD: Internal-external attributions relating to the causes of child behavior were compared across mothers at-risk of child abuse (n = 40) and mothers who reported no significant parental or child conduct or behavior problems (n = 20). Mothers' attributions about the causes of the behavior of their own child and an unfamiliar child were recorded in response to the presentation of videotaped excerpts of the behavior. RESULTS: Results highlighted that compared with nonclinic mothers, abuse-risk mothers had a tendency to attribute positive child behavior to more external causes and negative child behavior to more internal causes. Differences were also found between parental cognitions about clearly positive, clearly naughty, and ambiguous child behavior. In the abuse-risk group, positive child behavior predicted coercive parenting when it elicited angry feelings in the mother; ambiguous and naughty child behavior led to coercive parenting through valence ratings of "deviant" and attributions of "internality." Analyses within the abuse-risk group showed that parental attributions are predictive of parental coerciveness for unfamiliar behavior. As behavior becomes more familiar, ratings of its valence and the affect it elicits override attributional activity. CONCLUSIONS: Parental attributions about the causes of child behavior differ according to the valence and familiarity of that behavior, and discriminate between parents at risk for child abuse. Further, attributions are predictive of the affective and behavioral responses the parent makes to the child's behavior for ambiguous or unfamiliar behavior. Evidence was found for the validity of using videotaped stimuli of the behavior of known and unknown children as a method of assessing parental attributions.

Adult↗

Interaction of temperamental resistance to control and restrictive parenting in the development of externalizing behavior.

Child temperament and parental control were studied as interacting predictors of behavior outcomes in 2 longitudinal samples. In Sample 1, data were ratings of resistant temperament and observed restrictive control in infancy-toddlerhood and ratings of externalizing behavior at ages 7 to 10 years; in Sample 2, data were retrospective ratings of temperament in infancy-toddlerhood, observed restrictive control at age 5 years, and ratings of externalizing behavior at ages 7 to 11 years. Resistance more strongly related to externalizing in low-restriction groups than in high-restriction groups. This was true in both samples and for both teacher- and mother-rated outcomes. Several Temperament x Environment interaction effects have been reported previously, but this is one of very few replicated effects.

Child↗

Etiological models of child maltreatment. A behavioral perspective.

Child abuse and neglect are complex phenomena that require a multidisciplinary perspective. This article describes current etiological formulations of child maltreatment. Three models (ecological, transactional, and transitional) are described that delineate the multiple pathways leading to abuse and neglect. These approaches emphasize the interaction of causative factors in bringing about maltreatment and the importance of high- and low-risk characteristics that differentially influence the development of maltreatment. Behavioral explanations of child maltreatment are also discussed. Particularly relevant here are observational learning, anger control, and coercive family processes. Finally, the implications of our understanding of etiology to assessment, treatment, and prevention are outlined and considered.

Behavior Therapy↗

"Difficult" children as elicitors and targets of adult communication patterns: an attributional-behavioral transactional analysis.

A transactional model of adult-child interaction was proposed and tested. In determining the effects that caregivers and children have on each other, it was maintained that adult attributions act as important moderators in the interaction process. Specifically, it was predicted that adult beliefs about the causes of caregiving outcomes act as selective filters or sensitizers to child behavior--determining the nature and amount of adult reaction to different child behaviors. It was further predicted that adult attributions act in a self-fulfilling fashion, that is, the communication patterns that follow from caregiver beliefs act to elicit child behavior patterns that maintain those beliefs. In a synthetic family strategy, elementary-school-aged boys were paired with unrelated mothers (N = 96) for videotaped interactions. Children were either trained or preselected on two orthogonal dimensions: responsiveness and assertiveness. Mothers were premeasured on their self-perceived power as caregivers (S+) and the social power they attributed to children (C+). Videotapes were analyzed separately for adult facial expression and posture, voice intonation, and verbal communication. Each of these behavioral dimensions was measured on the dimensions of affect, assertion, and "maternal quality" (e.g., baby-talk). We expected low self-perceived power to sensitize the adult to variations in child responsiveness and high child-attributed power to sensitize the adult to variations in child assertiveness. Two transactional sequences were obtained (the same patterns were obtained for acted and dispositional enactments of child behavior): 1. Low S+ mothers (in comparison with high S+ mothers) were selectively reactive to child unresponsiveness. These adults reacted to unresponsive children with a communication pattern characterized by a "maternal" quality, negative affect, and positive affect that was unassertively inflected. Unresponsive children, in turn, reacted to low S+ mothers with continued unresponsiveness. 2. High C+ mothers (in contrast to low C+ mothers) were selectively reactive to child unassertiveness. These adults reacted to shy children with a "maternal," strong, and affectively positive communication style. Unassertive children, in turn, reacted to high C+ mothers with increased assertiveness. High S+ and low C+ mothers demonstrated no significant alterations in their behavior as a function of child behavior. This nonreactivity had positive consequences for child unresponsiveness (reduced) and negative consequences for child unassertiveness (maintained).(ABSTRACT TRUNCATED AT 400 WORDS)

Assertiveness↗

Bidirectional child-family influences on outcomes of traumatic brain injury in children.

Child behavior problems, injury-related family burden, and parent psychological distress were assessed longitudinally over the first year post injury in 40 children with severe traumatic brain injury (TBI), 52 with moderate TBI, and 55 with orthopedic injuries not involving brain insult. Parents rated children's preinjury behavior soon after injury. Postinjury child behavior and family outcomes were assessed at 6- and 12-month follow-ups. Findings from path analysis revealed both direct and indirect effects of TBI on child behavior and family outcomes, as well as cross-lagged child-family associations. Higher parent distress at 6 months predicted more child behavior problems at 12 months, controlling for earlier behavior problems; and more behavior problems at 6 months predicted poorer family outcomes at 12 months, controlling for earlier family outcomes. Support for bidirectional influences is tentative given that limited sample size precluded use of structural equation modeling. The findings nevertheless provide impetus for considering the influences of person-environment interactions on outcomes of TBI.

Brain Injuries↗

Child mania rating scale: development, reliability, and validity.

OBJECTIVE: To develop a reliable and valid parent-report screening instrument for mania, based on DSM-IVsymptoms. METHOD: A 21-item Child Mania Rating Scale-Parent version (CMRS-P) was completed by parents of 150 children (42.3% female) ages 10.3 +/- 2.9 years (healthy controls = 50; bipolar disorder = 50; attention-deficit/hyperactivity disorder [ADHD] = 50). The Washington University Schedule for Affective Disorders and Schizophrenia was used to determine DSM-IV diagnosis. The Young Mania Rating Scale, Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, Child Behavior Checklist, and Child Depression Inventory were completed to estimate the construct validity of the measure. RESULTS: Exploratory and confirmatory factor analysis of the CMRS-P indicated that the scale was unidimensional. The internal consistency and retest reliability were both 0.96. Convergence of the CMRS-P with the Washington University Schedule for Affective Disorders and Schizophrenia mania module, the Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, and the Young Mania Rating Scale was excellent (.78-.83). The scale did not correlate as strongly with the Conners parent-rated ADHD scale, the Child Behavior Checklist -Attention Problems and Aggressive Behavior subscales, or the child self-report Child Depression Inventory (.29-.51). Criterion validity was demonstrated in analysis of receiver operating characteristics curves, which showed excellent sensitivity and specificity in differentiating children with mania from either healthy controls or children with ADHD (areas under the curve of.91 to.96). CONCLUSION: The CMRS-P is a promising parent-report scale that can be used in screening for pediatric mania.

Adolescent↗

Pilot study of behavioral and emotional disturbances in the high-risk children of parents with opioid dependence.

OBJECTIVE: Despite the prevalence of nonalcohol substance abuse disorders, few data are available on the high-risk children of parents with these disorders. To this end as a preliminary study, children of opioid-dependent parents were assessed on measures of emotional and behavioral problems. METHOD: Child Behavior Checklist data from 15 girls and 29 boys (mean age 10.4 years) from 27 families of parents receiving treatment in a methadone maintenance clinic were compared with matched data from referred children with attention-deficit hyperactivity disorder plus comorbid psychiatric disorders ("comorbid ADHD children") and medically referred children without ADHD ("controls"). RESULTS: The children of opioid-dependent parents had significantly poorer competency scores, and higher scores on both Internalizing and Externalizing subscales of the Child Behavior Checklist, compared with controls (p values < .01), but not compared with comorbid ADHD children. Twenty-four children (55%) of opioid-dependent parents had elevated subscale scores indicative of significant psychopathology. CONCLUSIONS: These pilot data seem to indicate that the 4- to 18-year-old children of parents with opioid dependence have high rates of psychopathology and significant dysfunction and suggest the need for further controlled studies in this population.

Adolescent↗