An online family intervention to reduce parental distress following pediatric brain injury.

This study examined whether an online problem-solving intervention could improve parental adjustment following pediatric traumatic brain injury (TBI). Families of children with moderate-to-severe TBI were recruited from the trauma registry of a large children's hospital and randomly assigned to receive online family problem solving therapy (FPS; n = 20) or Internet resources (IRC; n = 20) in addition to usual care. The FPS group reported significantly less global distress, depressive symptoms, and anxiety at follow-up than did the IRC group after controlling for baseline symptoms. The FPS group also reported significant improvements in problem-solving skills, although the groups did not differ significantly at follow-up. Findings suggest that an online, skill-building approach can be effective in facilitating parental adaptation after TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An examination of differences between nonclinic and behavior-problem clinic-referred children and their mothers.

Attempted to determine if clinic and nonclinic groups differed according to the following factors: child behavior recorded in the home by an independent observer (O); maternal behavior recorded in the home by an independent O; mother-recorded rates of child behavior; maternal perceptions of child behavior; and presence of maternal depression, anxiety, and marital problems. The study also attempted to determine, by means of a stepwise discriminant analysis, which factor was the best discriminator of clinic–nonclinic status in children. Multiple regression analyses were used to examine which variables were the best predictors in each group of the discriminator variables delineated in the stepwise discriminant analysis. 20 behavior-problem clinic-referred 5-yr-olds and their mothers and 20 nonclinic 5-yr-olds and their mothers served as Ss. Results indicate that the 2 groups differed on child compliance recorded by an independent O and by the mother, maternal perception of child adjustment, and maternal adjustment. Maternal perception of child adjustment was the best discriminator between groups. For the nonclinic group maternal perceptions of child adjustment were best predicted by the child's behavior, whereas for the clinic group maternal perceptions of child adjustment were best predicted by an interaction of child behavior and the mother's personal adjustment. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent-child interactions during the initial weeks following brain injury in young children.

Objective: To understand how traumatic brain injury (TBI) affects parent-child interactions acutely following injury. Participants: Young children hospitalized for TBI (n = 80) and orthopedic injuries (OI; n = 113). Method: Raters coded videotaped interactions during free play and structured tasks for parental warmth/responsiveness and negativity and child warmth, behavior regulation, and cooperation. Raters also counted parental directives, critical/restricting statements, and scaffolds. Results: Parents of children with TBI exhibited less warm responsiveness and made more directive statements during a structured task than parents in the OI group. Children with TBI displayed less behavior regulation than children with OI. Parental warm responsiveness was more strongly related to child cooperativeness in the OI group than in the TBI group. Child behavior also mediated group differences in parental responsiveness and directiveness. TBI accounted for as much variance in parental behaviors as or more than did sociodemographic factors. Conclusion: TBI-related changes in child behavior may negatively influence parent-child interactions and disrupt the reciprocity between parent and child. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can a Web-based family problem-solving intervention work for children with traumatic brain injury?

Objective: To examine the feasibility and efficacy of a Web-based intervention for children with traumatic brain injury (TBI). Participants: 6 families comprising 8 parents, 5 siblings, and 6 children with TBI (mean age=10.5 years). Intervention: Families received computers, Web cameras, and Internet access. Participants completed 7-11 online sessions and accompanying weekly videoconferences with the therapist. Main Outcome Measures: Outcomes included child behavior problems, social competence, executive function skills, and parent-child conflict. Results: Children with TBI rated Web site content as very to extremely helpful and reported high overall satisfaction. There was a trend for children with TBI to rate the videoconferences as less helpful than did other family members and relative to a face-to-face visit. Parents reported improvements in antisocial behaviors, and children with TBI reported reductions in conflict with parents regarding school. Conclusions: Web-based interventions hold promise for improving child outcomes following pediatric TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Side effects of parent counseling on marital satisfaction.

In a study with 27 mothers and their clinic-referred children, mothers were divided into 3 groups based on their pretreatment level of marital satisfaction (Locke Marital Adjustment Test). Child compliance and deviant behavior as measured by independent observers, parent perceptions of child adjustment, and parent marital satisfaction were assessed before treatment, after treatment, and at a 2-mo follow-up. Parent counseling consisted of teaching mothers to reward appropriate behavior and use a time-out procedure for deviant behavior. All groups changed significantly from pre- to posttreatment on the child behavior measures and on parent perceptions of child adjustment. These changes were maintained at follow-up for child compliance and parent perceptions of child adjustment. The group of mothers with low marital satisfaction reported an increase in marital adjustment from pretreatment to posttreatment, but this effect was not maintained at the 2-mo follow-up. Groups with medium or high marital satisfaction reported no change in marital adjustment. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of parental warm responsiveness and negativity to emerging behavior problems following traumatic brain injury in young children.

Parenting behaviors play a critical role in the child's behavioral development, particularly for children with neurological deficits. This study examined the relationship of parental warm responsiveness and negativity to changes in behavior following traumatic brain injury (TBI) in young children relative to an age-matched cohort of children with orthopedic injuries (OI). It was hypothesized that responsive parenting would buffer the adverse effects of TBI on child behavior, whereas parental negativity would exacerbate these effects. Children, ages 3–7 years, hospitalized for TBI (n = 80) or OI (n = 113), were seen acutely and again 6 months later. Parent–child dyads were videotaped during free play. Parents completed behavior ratings (Child Behavior Checklist; T. M. Achenbach & L. A. Rescorla, 2001) at both visits, with baseline ratings reflecting preinjury behavior. Hypotheses were tested using multiple regression, with preinjury behavior ratings, race, income, child IQ, family functioning, and acute parental distress serving as covariates. Parental responsiveness and negativity had stronger associations with emerging externalizing behaviors and attention-deficit/hyperactivity disorder symptoms among children with severe TBI. Findings suggest that parenting quality may facilitate or impede behavioral recovery following early TBI. Interventions that increase positive parenting may partially ameliorate emerging behavior problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The family environment as a moderator of psychosocial outcomes following traumatic brain injury in young children.

Objective: This study sought to determine whether the family environment moderates psychosocial outcomes after traumatic brain injury (TBI) in young children. Method: Participants were recruited prospectively from consecutive hospital admissions of 3- to 6-year-old children, and included 19 with severe TBI, 56 with complicated mild/moderate TBI, and 99 with orthopedic injuries (OI). They completed 4 assessments across the first 18 months postinjury. The initial assessment included measures of parenting style, family functioning, and the quality of the home. Children's behavioral adjustment, adaptive functioning, and social competence were assessed at each occasion. Mixed model analyses examined the relationship of the family environment to psychosocial outcomes across time. Results: The OI and TBI groups differed significantly in social competence, but the family environment did not moderate the group difference, which was of medium magnitude. In contrast, group differences in behavioral adjustment became more pronounced across time at high levels of authoritarian and permissive parenting; among children with severe TBI, however, even those with low levels of permissive parenting showed increases in behavioral problems. For adaptive functioning, better home environments provided some protection following TBI, but not over time for the severe TBI group. These 3-way interactions of group, family environment, and time postinjury were all of medium magnitude. Conclusion: The findings indicate that the family environment moderates the psychosocial outcomes of TBI in young children, but the moderating influence may wane with time among children with severe TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Placement shift, sibling relationship quality, and child outcomes in foster care: A controlled study.

Sibling unity during family transitions is considered a protective factor for child behavior problems, but there is little empirical support for the widespread child protection policy of placing siblings together in foster care. In a prospective study of 156 maltreated children, siblings were classified in 1 of 3 placement groups: continuously together (n = 110), continuously apart (n = 22), and disrupted placement (siblings placed together were separated; n = 24). Changes in child adjustment as a function of sibling relationship and placement group were examined. Sibling positivity predicted lower child problems at follow-up (about 14 months later), while sibling negativity predicted higher child problems. Placement group did not affect child behavior problems at follow-up; however, compared to siblings in continuous placement (either together or apart), siblings in disrupted placement with high initial behavior problems were rated as having fewer problems at follow-up, while siblings in disrupted placement with low initial behavior problems were rated as having more problems at follow-up. These findings highlight the importance of considering relationships between siblings and the risk that one poses to another before early placement decisions are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teachers' interactions with middle- and lower SES preschool boys and girls.

Compared 9 preschool and 17 Head Start teachers' interactive behaviors with children of middle and lower socioeconomic status (SES). Observation data indicate that teachers of lower SES children had fewer verbal communications with them and more interactions with older adults. Data indicate that teachers of middle-SES children had higher rates of positive–neutral teacher initiation to children and higher rates of positive–neutral child initiation to teachers. Teachers of middle-SES children had a higher rate of negative initiation to boys than to girls. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mealtime behavior and parent-child interaction: a comparison of children with cystic fibrosis, children with feeding problems, and nonclinic controls

Examined the role of family interaction factors in dietary compliance problems reported by parents of children with cystic fibrosis (CF). The family mealtime interactions of children with CF, children with feeding problems and nonclinic controls were observed, and parents monitored children's eating behavior at home. Parents of children with CF reported more concern about feeding problems and recorded more disruptive mealtime behavior than parents of nonclinic children. Observational data showed children with CF to display overall rates of disruptive mealtime behavior not significantly different from either comparison group. Mothers of children with CF were observed to engage in higher rates of aversive interaction with their child than did mothers of nonclinic controls. Fathers of children with CF reported lower marital satisfaction than fathers of controls. Both mothers and fathers of children with CF reported lower parenting self-efficacy than non-CF families. Clinical implications are discussed.     

Relationships between marital distress and child behavior problems, maternal personal adjustment, maternal personality, and maternal parenting behavior.

Examined the relationship of marital adjustment to maternal personal adjustment, maternal personality, maternal perception of child adjustment, maternal parenting behavior, and child behavior using 20 maritally distressed and 20 maritally nondistressed mothers and their children (aged 3–7 yrs). Ss were given a battery of tests that included the Beck Depression Inventory, the Trait form of the State-Trait Anxiety Inventory, and the Personality Research Form—Form A. Results indicate that, compared to mothers in the maritally nondistressed group, mothers in the distressed group perceived themselves as significantly more anxious and depressed and perceived their children as having significantly more behavior problems, particularly in the area of undercontrol. There were no differences between the groups with respect to maternal personality. Maritally distressed mothers showed less appropriate parenting behavior than did nondistressed mothers and the children of maritally distressed mothers were more deviant than were children of nondistressed mothers. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of short- and long-term outcomes after traumatic brain injury in children: Behavior and achievement.

Longitudinal behavior and achievement outcomes of traumatic brain injury (TBI) were investigated in 53 children with severe TBI, 56 children with moderate TBI, and 80 children with orthopedic injuries not involving brain insult. Measures of preinjury child and family status and of postinjury achievement skills were administered shortly after injury. Assessments were repeated 3 times across a mean follow-up interval of 4 years. Results from mixed model analysis revealed persisting sequelae of TBI. Recovery of math skills was observed in the severe TBI group but only for children from less stressed families. Social disadvantage in children with TBI predicted more adverse behavioral sequelae and less favorable changes in some outcome measures. The findings suggest that pediatric TBI has long-term effects on behavior and achievement but that postinjury progress is influenced by the family environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of water pipelines on the quality of drinking water

Examined whether marital discord over childrearing contributes to child behavior problems after taking into account general marital adjustment, and if child age moderates associations between child behavior problems and either general marital adjustment or marital discord over childrearing. Participants were 146 two-parent families seeking services for their child's (4 to 9 years of age) conduct problems. Data on marital functioning and child behavior problems were collected from both parents. Mothers' and fathers' reports of marital discord over childrearing related positively to child externalizing problems after accounting for general marital adjustment. Child age moderated associations between fathers' reports of general marital adjustment and both internalizing and externalizing child problems, with associations being stronger in families with younger children. The discussion highlights the role that developmental factors may play in understanding the link between marital and child behavior problems in clinic-referred families.     

Clinically significant behavior problems during the initial 18 months following early childhood traumatic brain injury.

Objective: This study looked at the emergence of clinically significant problems in behavior, executive function skills, and social competence during the initial 18 months following traumatic brain injury (TBI) in young children relative to a cohort of children with orthopedic injuries (OI) and the environmental factors that predict difficulties postinjury. Participants: Children, ages 3–7 years, hospitalized for severe TBI, moderate TBI, or OI were seen shortly after their injury (M = 40 days) and again 6 months, 12 months, and 18 months postinjury. Design: Behavioral parent self-reports, demographic data, family functioning reports, and home environment reports were collected at injury baseline and each time point postinjury. Results: Results suggest that, compared with the OI group, the severe TBI group developed significantly more externalizing behavior problems and executive function problems following injury that persisted through the 18-month follow-up. Minimal social competence difficulties appeared at the 18-month follow-up, suggesting a possible pattern of emerging deficits rather than a recovery over time. Conclusions: Predictors of the emergence of clinically significant problems included permissive parenting, family dysfunction, and low socioeconomic status. The findings are similar to those found in school-age children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maladaptive development of school-aged, physically abused children: Relationships with the child-rearing context.

Examined the development of school-aged, physically abused children and the relationship of this development to the childrearing beliefs and practices of the abusive parents. The sample consisted of 29 physically abused children (aged 4–11 yrs) and their parents and a comparison group of 29 families matched on age, race, and gender of the child and family SES. A multimethod approach including interviews, standardized tests, Q sorts, parent record-keeping, and structured observation was used to assess the cognitive, social, and physical competence and behavior problems of the children and the childrearing context of the homes. The abused children had poorer cognitive maturity, interpersonal problem-solving skills, and social competence and many more behavior problems than the comparison children. In some instances, aspects of the childrearing context were stronger predictors of the children's development than was abuse group membership. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective study of postpartum depression: 4?-year follow-up of women and children.

The consequences of maternal postpartum depression for mothers and children were investigated in a 4?-yr follow-up study, which included 70 of 99 women who had participated in an earlier study of postpartum depression. Information about maternal adjustment and depression during the follow-up period and child adjustment at age 4? yrs was obtained. Women who had experienced a postpartum depression were predicted to be at increased risk for subsequent depression and poor adjustment of their child. Postpartum depression was directly related to subsequent depression but not child problems. Later depression was related to child problems at 4? yrs. We concluded that postpartum depression may increase risk for later maternal depression and in turn increases risk for child behavior problems. Intervening with women who have experienced a postpartum depression may reduce likelihood of future depressions and child behavior problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal depression and child adjustment: A longitudinal analysis.

This study examined the relation between maternal depression and child adjustment. Two major issues were addressed. First, to assess the specificity to depression of observed child adjustment difficulties, four groups of female subjects were included: clinically depressed psychiatric patients, nondepressed psychiatric patients, nondepressed medical patients, and nondepressed nonpatients. Second, to assess the stability of the observed effects, data were collected early in the patients' treatment and again approximately 8 weeks later. The results indicated that the depressed mothers described their children as having various behavior problems; interestingly, interviewers also rated these children as demonstrating disturbed behavior. Although the offspring of the depressed mothers were the most impaired children in the sample, the lack of significant differences between children of the depressed and the nondepressed psychiatric patients suggests that child adjustment is more strongly related to the presence of maternal psychopathology than it is to diagnostic status. Finally, children of the psychiatric patients continued to demonstrate problems at the second assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital adjustment and the efficacy of behavior therapy with children.

Parents of 62 children (from 49 intact and 13 one-parent families) referred to a behaviorally oriented child psychological clinic provided measures of marital adjustment (Short Marital Adjustment Test) and of their children's behavior (Behavior Problem Checklist) before and after treatment. Parents of 31 nonreferred children of the same age and socioeconomic status as the clinic sample provided the same self-report measures. Marital adjustment scores of clinic parents were significantly lower than those of the control sample, although there was considerable overlap between the distribution of scores. Further, there was a consistent negative correlation between marital adjustment and severity of children's behavior problems. However, pretreatment level of marital discord was not related to degree of positive behavior change observed at therapy termination or at a 5-mo follow-up. Difficulty in obtaining follow-up data from parents was correlated with a small degree of improvement in child behavior. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of age and ritalin dosage on the mother–child interactions of hyperactive children.

Observed interactions between mothers and 54 hyperactive children in 3 age groups (4 yrs to 5 yrs 11 mo, 6 yrs to 7 yrs 11 mo, and 8 yrs to 9 yrs 11 mo) during a drug–placebo evaluation of 2 daily dosages (0.3 and 1.0 mg/kg) of Ritalin (methylphenidate). Results indicate few age or drug effects on social interactions during free play; however, numerous age and drug effects were seen in the task period. With age, children increased their compliance and decreased their negative behavior, and their mothers decreased their levels of control and management. Both doses of methylphenidate increased child compliance equally, but only at the higher dose were significant drug effects found on mothers' behavior: Mothers decreased their control and negative behavior toward children during the high-dose condition. Drug effects on these interactions were not affected by children's ages. It is concluded that although the parent–child interactions of hyperactive children improve with age, methylphenidate produces further improvements in task-related interactions. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-Term Educational Interventions After Traumatic Brain Injury in Children.

Objectives: To track educational interventions received by children with traumatic brain injury (TBI), examine factors associated with placement in special education, and explore the concordance of placement with children's needs. Methods: Interventions were monitored in 42 children with severe TBI, 42 with moderate TBI, and 50 with orthopedic injuries only (ORTHO group). A baseline assessment was completed soon after injury. Follow-up assessments were conducted 6 and 12 months after the baseline and at an extended follow-up about 4 years postinjury. Results: Rates of special education were higher in the severe TBI group than in the ORTHO. Predictors of special education included TBI severity, socioeconomic status, and measures of pre- and postinjury child status. Several children with TBI with residual deficits who were in regular education prior to injury did not receive special education at the extended follow-up. Conclusion: Although special education is frequently provided for several years after severe TBI, existing programs are of limited scope. (PsycINFO Database Record (c) 2010 APA, all rights reserved)