A Multi-level Longitudinal Model of Risk Factors for Generalized and Separation Anxiety Symptoms in a Community Sample of 6-year-olds.

The current longitudinal study examined the relations between variables in four domains-contextual (SES, family conflict, stress), parent (caretaker depression), parenting (support hostility, autonomy granting), and child (negative affect, effortful control, sensory regulation, attachment)-and both the presence of generalized and separation anxiety symptoms at age 6 in a community sample of 796 children and the change in these anxiety symptoms from ages 4 to 6. Anxiety was highly stable over time. Specific results revealed both direct and indirect pathways between age 4 and age 5 variables, and age 6 anxiety. Caretaker depression and the child variables of attachment, effortful control, negative affect, and sensory regulation were directly related to anxiety symptoms at age 6. Contextual variables (SES) at age 4 were indirectly related to age 6 anxiety through parent depression at age 5. Parent depression was indirectly related to age 6 anxiety through age 5 child negative affect. Child negative affect at age 4 was indirectly related to age 6 anxiety through age 5 effortful control and age 4 effortful control was indirectly related to age 6 anxiety through age 5 negative affect. With the exception of attachment, there was a reduction in the impact of other variables when initial levels of anxiety symptoms were included in the model. Implications of results for early intervention and further study are discussed.

Multidomain risk factors in early childhood and depression symptoms in 6-year-olds: A longitudinal pathway model.

This study examined effects of risk factors in multiple domains measured in preschool and kindergarten on age 6 depression symptoms, and on changes in symptom levels between ages 4 and 6. Two models were examined in a large, diverse (N = 796) community sample of children and parents. Risk variables included SES, stress, conflict, parental depression, parental hostility, support, scaffolding, child negative affect (NA), effortful control (EC), sensory regulation (SR), and attachment security. Model 1 included effects of risk factors at ages 4 and 5 on child depression symptoms at age 6. Model 2 also included depression symptoms at all three ages to examine changes in these symptoms. Model 1 revealed that age 4 and 5 parental depression, NA, EC, and SR predicted age 6 child depression levels, Several age 4 variables had indirect pathways to age 6 depression via age 5 EC. Model 2 revealed that preschool depression was the only age 4 variable, and EC and SR were the only age 5 variables that significantly predicted increases in age 6 depression. These findings highlight the role of self-regulation in child depression and suggest that targeting self-regulation may be an effective prevention and intervention strategy.

Age 4 Predictors of Oppositional Defiant Disorder in Early Grammar School.

Our ability to predict which children will exhibit oppositional defiant disorder (ODD) at the time of entry into grammar school at age 6 lags behind our understanding of the risk factors for ODD. This study examined how well a set of multidomain risk factors for ODD assessed in 4-year-old children predicted age 6 ODD diagnostic status. Participants were a diverse sample of 796 4-year-old children (391 boys).The sample was 54% White, non-Hispanic; 16.8% African American, 20.4% Hispanic; 2.4% Asian; and 4.4% Other or mixed race. The classification accuracy of two models of multidomain risk factors, using either a measure of overall ODD symptoms or dimensions of ODD obtained at age 4, were compared to one another, to chance, and to a parsimonious model based solely on parent-reported ODD using Automated Classification Tree Analysis. Effect Strength for Sensitivity (ESS), a measure of classification accuracy, indicated a multidomain model including a general measure of ODD symptoms at age 4 yielded a large effect (56.29%), a 13.7% increase over the ESS for the parsimonious model (ESS = 42.9%). The ESS (51.23%) for a model including two ODD dimensions (behavior and negative affect) was smaller than that for the model including a measure of overall ODD symptoms. The Classification Tree Analysis approach showed a small but distinct advantage that would be useful in screening for which children would most likely meet criteria for age 6 ODD.

The relation between social support, anxiety and distress symptoms and maternal fetal attachment.

OBJECTIVE: The aims of this study were to: (1) examine the relation between social support, trait anxiety, symptoms of maternal distress (including stress, depression and anxiety) and maternal-fetal attachment; and (2) to determine if social support buffers the relation between trait anxiety, symptoms of distress and maternal-fetal attachment. DESIGN: Ninety-four pregnant women completed five self-report questions. Two hierarchical regression analyses were conducted to examine the influence of trait anxiety, symptoms of distress, and social support on two factors of maternal-fetal attachment, quality and intensity/frequency. RESULTS: In the first model with the dependent measure as the maternal-fetal attachment quality score, trait anxiety (ß = -.24, p < .05) and social support (ß = .30, p < .01) were significant predictors, accounting for 18% of the variance. In the second model with the dependent measure as the maternal-fetal attachment intensity/frequency score, trait anxiety (ß = -.23, p < .05) and social support (ß = .32, p < .01) were significant predictors, accounting for 23% of the variance. In addition, the interaction term contributed a significant 4% of the variance, indicating that when social support is high, the relation between anxiety and maternal-fetal attachment intensity/frequency is attenuated. CONCLUSIONS: This study demonstrates that prenatal attachment is related to trait anxiety and social support. These findings suggest that interventions to decrease anxiety and increase social support could enhance maternal-fetal attachment.

A multidomain cascade model of early childhood risk factors associated with oppositional defiant disorder symptoms in a community sample of 6-year-olds.

The present study examined a cascade model of age 4 and 5 contextual, parent, parenting, and child factors on symptoms of oppositional defiant disorder (ODD) at age 6 in a diverse community sample of 796 children. Contextual factors include socioeconomic status, family stress, and conflict; parent factors included parental depression; parenting factors included parental hostility, support, and scaffolding skills; child factors included child effortful control (EC), negative affect (NA), and sensory regulation. Direct effects of age 5 conflict, hostility, scaffolding, EC, and NA were found. Significant indirect, cascading effects on age 6 ODD symptom levels were noted for age 4 socioeconomic status via age 5 conflict and scaffolding skills; age 4 parental depression via age 5 child NA; age 4 parental hostility and support via age 5 EC; age 4 support via age 5 EC; and age 4 attachment via age 5 EC. Parenting contributed to EC, and the age 5 EC effects on subsequent ODD symptom levels were distinct from age 5 parental contributions. Scaffolding and ODD symptoms may have a reciprocal relationship. These results highlight the importance of using a multidomain model to examine factors associated with ODD symptoms early in the child's grammar school years.

Multi-domain Predictors of Attention Deficit/Hyperactivity Disorder Symptoms in Preschool Children: Cross-informant Differences.

Numerous studies indicated that agreement between parent and teacher ratings of symptoms of attention-deficit/hyperactivity disorder in children of all ages is poor, but few studies have examined the factors that may be associated with rater differences. The present study examined the contextual, parent, parenting, and child factors associated with rater differences in a community sample of 4-year-old children. Parents and teachers of 344 4-year-olds recruited from preschools and pediatric practices completed the preschool versions of the Child Symptom Inventory. Measures of socioeconomic status, family stress and conflict, caretaker depression, parental hostility, support-engagement, and scaffolding skills, and child negative affect (NA), sensory regulation (SR), effortful control (EC), inhibitory control, and attachment security were obtained either by parental report or observational measures. χ 2 difference tests indicated that child factors of EC and SR, and contextual factor of stress and conflict, contributed more to parent-ratings of ADHD-I and ADHD-HI than to teacher-ratings of those same types of symptoms. Two factors contributed more to teacher-than to parent-rated ADHD-I, NA and caretaker depression. Results indicate there are differences in factors associated with ADHD symptoms at home and school, and have implications for models of ADHD.

Multi-domain predictors of oppositional defiant disorder symptoms in preschool children: cross-informant differences.

Existing research suggests that parent and teacher reports of children's behavior problems are often discrepant. The current study examined whether contextual (stress and family conflict), parent (depression), parenting (hostility, support, and scaffolding), and child factors (receptive vocabulary; negative affect, NA; effortful control, EC; inhibitory control, IC; attachment; and sensory regulation, SR) are related to parent-teacher reporting discrepancies. Participants included a community sample of 344 4-year-old children. A multi-informant approach was used to assess contextual, parent, parenting, and child factors. Parents and teachers completed the Oppositional Defiant Disorder (ODD) scale of the Child Symptom Inventory. Consistent with previous data, there was poor agreement between parents and teachers (r = .17). After correcting for multiple comparisons, child effortful control, parent hostility, and family conflict were significant predictors of parent-rated symptoms of ODD symptoms but not teacher-rated ODD symptoms. Only family conflict was a significant predictor of discrepancies in parent and teacher ratings.

A Precision Mental Health Model for Predicting Stability of 4-year-olds' Attention Deficit/Hyperactivity Disorder Symptoms to Age 6 Diagnostic Status.

OBJECTIVE: Estimates of the stability of a preschooler's diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) into early elementary school vary greatly. Identified factors associated with diagnostic instability provide little guidance about the likelihood a particular child will have ADHD in elementary school. This study examined an approach to predicting age 6 ADHD-any subtype (ADHD-any) from preschoolers' demographics and ADHD symptoms. METHOD: Participants were 796 preschool children (Mage = 4.44; 51% boys; 54% White, non-Hispanic) recruited from primary pediatric care and school settings. Parents completed ADHD Rating Scales at child ages 4 and 5 years, and a structured diagnostic interview (DISC-YC) at ages 4 and 6. Classification tree analyses (CTAs) examined the predictive utility of demographic and symptom variables at ages 4 and 5 years for age 6 ADHD. RESULTS: Over half (52.05%) of preschoolers meeting diagnostic criteria for ADHD-any at age 4 did not meet those criteria at age 6; more than half (52.05%) meeting criteria for ADHD-any at age 6 had not met those criteria at age 4. A CTA conducted at age 4 predicted age 6 ADHD-any diagnosis 65.82% better than chance; an age 5 CTA predicted age 6 ADHD-any 70.60% better than chance. At age 4, likelihood of age 6 ADHD-any diagnosis varied from <5% to >40% across CTA tree branches and from <5% to >78% at age 5. CONCLUSIONS: Parent-reported patterns of preschool-age symptoms may differentially predict ADHD-any at age 6. Psychoeducation regarding these patterns may aid in decision about pursuing multidisciplinary evaluations or initiating treatment.

Gene × environment effects of serotonin transporter, dopamine receptor D4, and monoamine oxidase A genes with contextual and parenting risk factors on symptoms of oppositional defiant disorder, anxiety, and depression in a community sample of 4-year-old children.

Genetic factors can play a key role in the multiple level of analyses approach to understanding the development of child psychopathology. The present study examined gene-environment correlations and gene × environment interactions for polymorphisms of three target genes, the serotonin transporter gene, the D4 dopamine receptor gene, and the monoamine oxidase A gene in relation to symptoms of anxiety, depression, and oppositional behavior. Saliva samples were collected from 175 non-Hispanic White, 4-year-old children. Psychosocial risk factors included socioeconomic status, life stress, caretaker depression, parental support, hostility, and scaffolding skills. In comparison with the short forms (s/s, s/l) of the serotonin transporter linked polymorphic repeat, the long form (l/l) was associated with greater increases in symptoms of oppositional defiant disorder in interaction with family stress and with greater increases in symptoms of child depression and anxiety in interaction with caretaker depression, family conflict, and socioeconomic status. In boys, low-activity monoamine oxidase A gene was associated with increases in child anxiety and depression in interaction with caretaker depression, hostility, family conflict, and family stress. The results highlight the important of gene-environment interplay in the development of symptoms of child psychopathology in young children.

Direct and indirect effects of contextual factors, caregiver depression, and parenting on attachment security in preschoolers.

The aim of this study was to develop a multiple-level-of-analysis model of preschool attachment security and to determine the processes (direct and indirect) whereby factors from different domains (e.g., stress and parenting) are related to attachment during this period. This study examined the direct and indirect effects of stress, family conflict, caregiver depression symptoms, and parenting on attachment security in a large (N = 796) and diverse sample of 4-year-olds. This study used the 3-Boxes Task to assess aspects of parenting critical to sensitivity in the preschool period, labeling this construct sensitivity/scaffolding. Parent-report questionnaires were used to assess stress, conflict, caregiver depressive symptoms, parent support/engagement, and parent hostility/coercion. Direct observation (3-Boxes Task) was used to assess sensitivity/scaffolding and attachment (Attachment Q-Sort) based on a 2½-3 hour home visit. Results of structural equation modeling indicated a good overall fit for the model. Among the parenting variables, sensitivity/scaffolding had the strongest effect on attachment. Depressive symptoms had both direct and indirect effects (mediated by parenting). The effects of stress and family conflict were mediated by caregiver depression symptoms and parenting. These data show that a developmentally appropriate measure of sensitivity plays a significant role in attachment security in preschoolers. Thus, strategies designed to enhance sensitivity/scaffolding may increase child resilience by enhancing attachment security.