Übersichtsarbeiten / Review Articles. Was wollen wir (diagnostizieren) und was sollten wir diagnostizieren. Ein systemischer Überblick und Ausblick / What Would we Like to (Diagnose) and what do we have to Diagnose. A Systemic Overview and Perspective.

What Would we Like to (Diagnose) and what do we have to Diagnose. A Systemic Overview and Perspective Behavioral problems in children and young people are currently quickly suspected of being a sign of a psychological problem or a psychiatric disorder. In many cases, the caregivers agree on this, but in others there are clearly different perspectives from obvious to possible diagnoses. Whether a diagnosis makes sense and whether appropriate diagnostics are effective depends on various factors. From a systemic perspective, the common process, the symptomatic patients and their environment benefit from a solution- and resource-oriented view, which should have a greater impact on the future design of classifications of health and illness.

Screen time and social-emotional skills in preschoolers with developmental, behavioural or emotional issues in Singapore.

Introduction: This study aimed to determine patterns of screen viewing time (SVT) in preschool children with developmental, behavioural or emotional (DBE) issues, and to identify its relationship with social-emotional development. Method: This cross-sectional study involved children aged 0-5 years who were referred to a developmental paediatric clinic for DBE issues. Parents completed a screen time questionnaire, and the Devereux Early Childhood Assessment-Clinical (DECA-C) question-naire which assessed the social-emotional competence of the children. Data were analysed using logistic regression, correlational analyses and tests of comparison. Results: Among 225 children (mean age: 32.4 months), mean daily SVT was 138 minutes. More than half (51.1%) of the children had clinical features of language delay, while 26.6% had features suggestive of autism spectrum disorder. Screen time was first introduced at a mean age of 13.8 months, with 32.4% of children previously experiencing higher SVT. Compared to SVT introduction after 1 year of age, SVT in the first 12 months was primarily to facilitate feeding (P<0.05). Children with higher past SVT had poorer attention, more aggression, and increased behavioural concerns. Children with DBE issues have significantly more screen time than same-aged peers. Conclusion: Children with DBE issues are exposed to SVT at a very young age and have significantly more screen time than their peers. It is crucial to guide parents to reduce SVT in early childhood, particularly around mealtimes.

Adverse event assessment in a parenting programme: experiences from a multisite randomised controlled trial.

BACKGROUND: Clinicians and researchers should consider the expected benefits and potential harms of an intervention. Parenting programmes are a widely used evidence-based intervention for child behaviour problems. However, few data are available on potential negative effects. The aims of this paper were to increase systematic knowledge of adverse event (AE) assessment in parenting programmes and to provide an AE assessment tool. METHODS: As part of the RISE project (prevention of child mental health problems in South-eastern Europe-adapt, optimise, test and extend parenting for lifelong health), we developed and tested an AE assessment procedure in three sequential studies for parents of children with child behaviour problems aged 2 to 9 years in North Macedonia, Republic of Moldova, and Romania. This paper reports on the development of the assessment tool in phase 1 (N = 140), phase 2 (N = 835), and the final experiences with using the optimised procedures in phase 3 (multisite randomised controlled trial, N = 823) in which AEs were assessed before, three times during intervention delivery, and at 1 year follow-up. At each time point, the participants completed a 12-item AE checklist. If moderate-to-severe problems of parent or child were reported, a structured follow-up interview was conducted. RESULTS: The response rate on the AE assessment tool increased from 6% (phase 1) to 100% (phase 3) indicating improvement in collecting these data based on the experiences of each phase. Results of the RCT (phase 3) showed generally low (S)AE frequencies with the finally optimised procedure: During the intervention, no serious adverse events (SAE) were registered; at least one AE was reported by 10% (after the first session), 7% (after the third session), and 4% (after the last fifth session) of participants. None of the identified (S)AEs was causally related to the study or intervention. Cost-benefit considerations are needed to determine the best way to ensure participant safety in parenting programmes. CONCLUSION: The applied active AE assessment procedure provides a comprehensive AE assessment tool that can be used by others-with adaptations for the specific context, if needed. Based on our experiences, we outline recommendations for future studies. TRIAL REGISTRATION: ClinicalTrials.gov, registration number phase 1: NCT03552250; phase 2: NCT03865485, phase 3: NCT04721730 . Registered on 13 January 2021.

Mothers' and their children's emotional and behavioral symptom trajectories and subsequent maternal adjustment: Twenty-seven years of motherhood.

BACKGROUND: This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems). METHODS: The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4-5, 8-9, 16-17, and 26-27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4-5, 8-9, and 16-17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26-27 years after the birth of the first child. Complete follow-up data were available for 168 mothers. RESULTS: We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning. LIMITATIONS: Maternal and child measures were based on maternal reports only. CONCLUSIONS: The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children.

Exposure to Operative Anesthesia in Childhood and Subsequent Neurobehavioral Diagnoses: A Natural Experiment Using Appendectomy.

BACKGROUND: Observational studies of anesthetic neurotoxicity may be biased because children requiring anesthesia commonly have medical conditions associated with neurobehavioral problems. This study takes advantage of a natural experiment associated with appendicitis to determine whether anesthesia and surgery in childhood were specifically associated with subsequent neurobehavioral outcomes. METHODS: This study identified 134,388 healthy children with appendectomy and examined the incidence of subsequent externalizing or behavioral disorders (conduct, impulse control, oppositional defiant, attention-deficit hyperactivity disorder) or internalizing or mood or anxiety disorders (depression, anxiety, or bipolar disorder) when compared to 671,940 matched healthy controls as identified in Medicaid data between 2001 and 2018. For comparison, this study also examined 154,887 otherwise healthy children admitted to the hospital for pneumonia, cellulitis, and gastroenteritis, of which only 8% received anesthesia, and compared them to 774,435 matched healthy controls. In addition, this study examined the difference-in-differences between matched appendectomy patients and their controls and matched medical admission patients and their controls. RESULTS: Compared to controls, children with appendectomy were more likely to have subsequent behavioral disorders (hazard ratio, 1.04; 95% CI, 1.01 to 1.06; P = 0.0010) and mood or anxiety disorders (hazard ratio, 1.15; 95% CI, 1.13 to 1.17; P < 0.0001). Relative to controls, children with medical admissions were also more likely to have subsequent behavioral (hazard ratio, 1.20; 95% CI, 1.18 to 1.22; P < 0.0001) and mood or anxiety (hazard ratio, 1.25; 95% CI, 1.23 to 1.27; P < 0.0001) disorders. Comparing the difference between matched appendectomy patients and their matched controls to the difference between matched medical patients and their matched controls, medical patients had more subsequent neurobehavioral problems than appendectomy patients. CONCLUSIONS: Although there is an association between neurobehavioral diagnoses and appendectomy, this association is not specific to anesthesia exposure and is stronger in medical admissions. Medical admissions, generally without anesthesia exposure, displayed significantly higher rates of these disorders than appendectomy-exposed patients.

Predicting externalizing behaviors in typically developing toddlers at 24 months: Insights from parenting at 12 months.

Early observational assessment of parent and child behaviors may identify risk factors associated with the development of early child externalizing behaviors. This study aimed to examine factors associated with child externalizing behaviors at 24-months of age, including early maternal depression, family social risk and the parent-child relationship. Using a longitudinal design in 89 mother-child dyads (n = 43 female), maternal depressive symptoms and social risk were measured post-birth, and 12-months later parent-child interaction was assessed using the Emotional Availability Scales. To assess child externalizing behaviors, a parent-report questionnaire was administered when children were 24-months old. Increased early maternal depressive symptoms (p = .03), but not higher social risk (p = 0.17), were associated with higher child externalizing behaviors in children at age 24-months. After adjusting for early maternal depressive symptoms and familial social risk, lower levels of observed maternal structuring (ß = -2.60, 95 %CI = -4.56, -0.64, p = .01) and lower levels of non-hostility (ß = -3.39, 95 %CI -6.64, -0.14, p = .04) when the child was 12-months old were associated with higher parent-report of externalizing behaviors. However, the child's observed interaction behavior was not associated with the mother's report of child externalizing behavior. Interventions targeting specific post-natal maternal mental health and early parenting behaviors may reduce the risk for the development of later child externalizing problems.

Psychometric properties of the Norwegian version of the Strength and Difficulties Questionnaire in a preschool sample.

PURPOSE: The Strength and Difficulties Questionnaire (SDQ) is widely used internationally, however less so in preschool populations and validations studies are thus needed. This study examined the psychometric properties of the Norwegian version parent report of the SDQ - preschool version (SDQ 2-4). MATERIALS AND METHODS: Parents of 289 Norwegian children in the age span 1-6 years old filled out the SDQ 2-4, the Child Behavior Checklist (CBCL), and background information. Internal consistency, factor structure, and convergent validity were assessed. RESULTS: The results showed satisfying internal consistency for the total difficulties score, but worse for some of the subscales. The five-factor structure showed a good fit. Good convergent and divergent validity was found in terms of correlations with CBCL. Sex differences were found on all scales, boys scoring higher on all problem scales. CONCLUSIONS: The SDQ 2-4 can be a promising instrument to screen for emotional and behavioral difficulties among Norwegian preschoolers, particularly in high-risk populations.

Measurement invariance of the Child Behavior Checklist (CBCL) across race/ethnicity and sex in the Adolescent Brain and Cognitive Development (ABCD) study.

There are numerous studies examining differences in the experience of disorders and symptoms of psychopathology in adolescents across racial or ethnic groups and sex. Though there is substantial research exploring potential factors that may influence these differences, few studies have considered the potential contribution of measurement properties to these differences. Therefore, this study examined whether there are differences across racial or ethnic groups and sex in the measurement of psychopathology, assessed in mother-reported behavior of 9-11 year old youth from the Adolescent Brain Cognitive Development study sample using updated Child Behavior Checklist scales (CBCL; Achenbach & Rescorla, 2001). Tests of measurement invariance of the CBCL utilized the higher order factor structure identified by Michelini et al. (2019) using this same Adolescent Brain Cognitive Development cohort. The dimensions include internalizing, somatoform, detachment, externalizing, and neurodevelopmental problems. The configural model had a good-to-excellent fit on all subscales of the CBCL across racial or ethnic groups and sex. The metric and scalar models fit just as well as the configural models, indicating that the scales are measuring the same constructs across racial or ethnic groups and sex and are not influenced by measurement properties of items on the CBCL, although some high-severity response options were not endorsed for youth in all racial or ethnic groups. These findings support the use of the CBCL in research examining psychopathology in racially or ethnically diverse samples of youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adaptive, Externalizing, and Internalizing Behavior of Children with Prenatal Alcohol Exposure: A Comparison of Three Parent-Report Questionnaires.

This study compared the Behavior Assessment System for Children-Third Edition (BASC-3) to the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales-Third Edition (VABS-3) in children with and without histories of prenatal alcohol exposure. Data were collected from Collaborative Initiative on Fetal Alcohol Spectrum Disorders Phase 4 sites. Caregivers rated their child's behavior using three questionnaires: BASC-3, CBCL, and VABS-3. BASC-3 Adaptive Skills, Externalizing Problems, and Internalizing Problems scores were correlated with comparable scores from the CBCL (Externalizing and Internalizing Problems) and VABS-3 (Adaptive Skills) both within and across groups. Sensitivity, specificity, and positive and negative predictive values were calculated for the BASC-3. BASC-3 sensitivity rates were 78.1%, 80.5%, and 47.0% and specificity rates were 79.4%, 80.4%, and 81.5% for Adaptive Skills, Externalizing Problems, and Internalizing Problems, respectively. Positive predictive values were 87.1%, 88.0%, and 81.9% and negative predictive values were 67.0%, 69.8%, and 46.3% for Adaptive Skills, Externalizing Problems, and Internalizing Problems, respectively. Results replicated previous reports of behavioral and adaptive difficulties in children with prenatal alcohol exposure. These findings provide support for using the BASC-3 in this population.

Early emotional and behavioural problems predict use of habilitation services among children: Findings from a longitudinal follow-up study.

PURPOSE: To explore the association between early emotional and behavioural problems and use of habilitation services among children in Sweden. METHODS: In this longitudinal cohort study, we used data on children, 3-5 years of age, whose mothers (n = 7343) and fathers (n = 6322) had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems, and who were followed for approximately 6.5 years with regard to use of habilitation services. The relations between emotional and behavioural problems and use of habilitation services were explored through cox regression models. RESULTS: In unadjusted models, children with identified emotional and behavioural problems were more likely to utilise habilitation services compared to those with no identified problems. These associations were shown for both mothers' (HR: 5.02) and fathers' (HR: 4.25) SDQ ratings. In adjusted cox-regression models, the associations remained significant for both mothers' (AHR: 4.24) and fathers' (AHR: 4.03) ratings. CONCLUSIONS: Early emotional and behavioural problems predict later habilitation service use among children in Sweden. Assessment of these problems in all children at child health services could facilitate early identification and timely interventions. Habilitation centres in Sweden could integrate mental health care into the standard treatment for children using these services.

First evaluation of Eyberg Child Behavior Inventory for foster children in Japan.

BACKGROUND: Behavioral problems of foster children are an important issue for the maintenance of the foster care system, but they have not been adequately studied in Japan. We used the Eyberg Child Behavior Inventory (ECBI) to investigate behavioral problems among foster children and to examine associated factors. METHODS: Twenty-nine foster children and their foster parents and 479 non-foster children and parents were recruited for the foster and control groups, respectively. Both groups underwent statistical comparative analyses using data from their ECBI assessments. The ECBI has two scales: the Intensity Scale quantifies the severity of child behavioral problems, and the Problem Scale captures the caregiver's perceived difficulties handling each behavior. We conducted a retrospective investigation of the background of the foster parent-child pairs to explore potential causal relationships with behavioral problems. RESULTS: The mean intensity score for the foster group was significantly higher than that for the control group (p = 0.001). The mean problem scores for the foster group and the control group were not significantly different (p = 0.79). In the foster group, the retrospective investigation revealed two children with neurological or neurodevelopmental disorders, 17 with histories of abuse, and 10 with other issues. CONCLUSION: Intensity scores showed severe behavioral problems among foster children, perhaps caused by neurological disorders, abuse, parental mental health, or economic hardship. Problem scores showed no significant differences between groups. It can therefore be posited that foster parents might exhibit a more lenient parenting style when dealing with children who have a history of abuse by their biological parents.

The assessment of preschool children with ESSENCE symptoms: concordance between parents, preschool teachers and child psychologists.

BACKGROUND: It is important to detect children with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE) in order to implement early intervention and support for the child and family. Standardized instruments for assessment in different contexts of behaviour problems, engagement and psychosocial health obtain an objective picture of the preschool child's mental health. AIM: To explore and compare parents', preschool teachers' and child health care psychologists' assessment of behaviour, everyday function, engagement, social interaction and psychosocial health in children with ESSENCE symptoms. METHOD: Parents of 152 children (114 boys and 38 girls, 4.5 ± 1 years) with ESSENCE symptoms, 155 preschool teachers and 8 child psychologists participated. Parents and preschool teachers assessed externalizing and internalizing behavioural problems using the Strengths and Difficulties Questionnaire (SDQ), including the SDQ supplement for assessing the impact of behavioral problems on daily function. Preschool teachers also assessed engagement and social interaction using the Children's Engagement Questionnaire (CEQ), and the child psychologists assessed psychosocial health with the Child Psychosocial Health Assessment (LillaLAPS) and template in conversations with parents of children with neurodevelopmental problems. RESULTS: Parents', preschool teachers' and child psychologists' assessment of the child's ESSENCE symptoms overall agreed. Both parents and preschool teachers see a strength in the child's social abilities. Differences in mean values show that parents assess more conduct, emotional symptoms and problems in daily life and more social skills, compared to the preschool teachers rating more peer problems. CONCLUSION: It is important to consider different contexts to identify the child's need for support in everyday life. Expanded use of validated screening instruments in clinical practice would promote detection of children not already identified as exhibiting neurodevelopmental problems.

Computerized adaptive testing to screen pre-school children for emotional and behavioral problems.

Questionnaires to detect emotional and behavioral (EB) problems in preventive child healthcare (PCH) should be short; this potentially affects their validity and reliability. Computerized adaptive testing (CAT) could overcome this weakness. The aim of this study was to (1) develop a CAT to measure EB problems among pre-school children and (2) assess the efficiency and validity of this CAT. We used a Dutch national dataset obtained from parents of pre-school children undergoing a well-child care assessment by PCH (n = 2192, response 70%). Data regarded 197 items on EB problems, based on four questionnaires, the Strengths and Difficulties Questionnaire (SDQ), the Child Behavior Checklist (CBCL), the Ages and Stages Questionnaire: Social Emotional (ASQ:SE), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Using 80% of the sample, we calculated item parameters necessary for a CAT and defined a cutoff for EB problems. With the remaining part of the sample, we used simulation techniques to determine the validity and efficiency of this CAT, using as criterion a total clinical score on the CBCL. Item criteria were met by 193 items. This CAT needed, on average, 16 items to identify children with EB problems. Sensitivity and specificity compared to a clinical score on the CBCL were 0.89 and 0.91, respectively, for total problems; 0.80 and 0.93 for emotional problems; and 0.94 and 0.91 for behavioral problems.    Conclusion: A CAT is very promising for the identification of EB problems in pre-school children, as it seems to yield an efficient, yet high-quality identification. This conclusion should be confirmed by real-life administration of this CAT. What is Known: • Studies indicate the validity of using computerized adaptive test (CAT) applications to identify emotional and behavioral problems in school-aged children. • Evidence is as yet limited on whether CAT applications can also be used with pre-school children. What is New: • The results of this study show that a computerized adaptive test is very promising for the identification of emotional and behavior problems in pre-school children, as it appears to yield an efficient and high-quality identification.

Physiological Dysregulation in Children With and Without Externalizing Difficulties: Novel Insights From Intensive Longitudinal Data.

Extant research on physiological dysregulation in children has focused on point-in-time measures and absolute mean levels of physiology. However, these methods do not capture dynamic fluctuations in physiology that characterize dysregulation. In the present work, we aimed to assess whether physiological dysregulation as captured by fluctuations rather than mean levels would differentiate between children with and without clinically elevated levels of externalizing behavior. As an exploratory approach, we examined fluctuations in children's physiological responses (i.e., root mean square of successive differences [RMSSD] in beat-to-beat heart rate intervals) to social transgression scenarios across 15 short-term measurement occasions (5-second bins). Controlling for mean RMSSD, as well as emotional and cognitive correlates of externalizing behavior (i.e., sympathy and inhibitory control), children with externalizing difficulties exhibited greater within-person fluctuations in RMSSD (i.e., physiological dysregulation) compared to children without externalizing difficulties. The present findings provide preliminary support for using intensive longitudinal data comprised of short-term physiological measurements and point to the centrality of within-child physiological variability as a marker of dysregulation, particularly amongst children with externalizing disorders for whom self-regulation is a core challenge.

The Premise, Promise, and Challenges of Intensive Assessment and Dynamic Quantitative Methods for Child and Adolescent Externalizing Problems.

This commentary discusses how papers from the Special Issue fill important gaps in the measurement and quantification of dynamic processes of child behaviors and parent-child interactions linked to child externalizing symptoms. After highlighting some of the innovative qualities of selected papers, challenges and future directions for the development of intensive measurement and dynamic quantitative methods are described. These topics follow from a developmental psychopathology framework that emphasizes measurement using both micro and macro methods, longitudinal research designs, and the recruitment of children that demonstrate clinically meaningful levels of externalizing problem behavior.

Using Daily Diary Assessments to Better Understand the Role of Parental Consistency in the Development of Externalizing Child Behavior.

Consistent discipline is thought to reduce early child externalizing behavior. It is unclear, however, whether consistency is important mainly within episodes of misbehavior (e.g., threatening with discipline but then giving in) or across episodes of misbehavior (e.g., disciplining each instance of misbehavior). Using a daily diary approach, we examine whether these two types of consistency are associated with disruptive child behavior, concurrently and prospectively. We included two samples (Sample 1: N = 134, Magechild = 30 months, 44% girls; Sample 2: N = 149, Magechild = 5.88 years; 46% girls, at-risk sample) with daily reports of child disruptive behavior and parental responses (Sample 1 = 7 days; Sample 2 = 14 days). Sample 1 parents additionally reported on their reactions over the past month and their child's externalizing behavior one year later. Within-episode consistency was assessed by the average number of parental reactions per episode; across-episode consistency by the Index of Qualitative Variation; and general consistency by parents' report of how they had responded to child disruptive behavior in the past month. In both samples correlations between within- and across-episode consistency were significant, but not so strong that they were not differentiated. Again in both samples, regression analyses provided evidence for unique predictive value of across-episode, not within-episode, consistency for daily disruptive behavior. Parental general consistency was longitudinally associated with fewer externalizing problems, whereas within- and across-episode consistency were not. It appears meaningful to differentiate within- from across-episode consistency to better understand the relevance of different aspects of consistency.

Investigating the factorial structure and measurement invariance of the parent-reported strengths and difficulties questionnaire at 11 years of age from the UK Millennium Cohort Study.

The strengths and difficulties questionnaire (SDQ) consist of five sub-scales that have been used to measure internalising and externalising symptoms in children, typically by combining sum scores of two sub-scales each, and pro-social behaviours. However, the different possible factorial structures that represent these symptoms have not been formally tested in a nationally representative sample of UK children. In addition, it is necessary to assess whether the SDQ is interpreted similarly across subgroups of the population. Exploratory and confirmatory factor analysis were used to test three competing structures for the parent-reported SDQ collected at age 11, the start of adolescence, in the UK Millennium Cohort Study (n = 11,519), and measurement invariance was assessed according to sex and a measure of deprivation of the area in which households lived. Internal consistency using ordinal alpha, internal convergent validity and external discriminant validity using average variance explained (AVE), and predictive validity were assessed. A five-factor model and a model with two second-order factors for internalising and externalising symptoms had better model fit than a three-factor model. For both structures, invariance was demonstrated across sex and area-level deprivation. AVE scores for the five-factor model indicated that peer and emotional problems factors were measuring a similar construct, as were the hyperactivity and conduct factors. In the second-order model, AVE scores indicated internalising and externalising symptoms were distinct constructs. A second-order model with two factors for internalising and externalising symptoms is appropriate for use in a cohort of UK children born in 2001/02, and our finding of invariance across sex and area-level deprivation indicate that the SDQ can be used in analysis investigating differences in symptoms across subgroups of the population.

Maternal social isolation and behavioral problems in preschool children: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study.

It is essential to clarify factors associated with mental health and behavioral problems in early childhood, because children are critical stages of life for mental health. We aimed to prospectively examine the associations between maternal social isolation and behavioral problems in preschool children. We analyzed data from 5842 mother-child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. The Lubben Social Network Scale-abbreviated version was used to assess social isolation (defined as scores < 12) one year after delivery. The Child Behavior Checklist 1½-5 was used to assess behavioral problems, and its subscales were used to assess internalizing and externalizing problems in children at 4 years of age. Multiple logistic regression analyses were conducted to examine the associations between social isolation and behavioral problems, after adjustment for age, education, income, work status, marital status, extraversion, neuroticism, depressive symptoms, child sex, and number of siblings. Multiple logistic regression analyses were also conducted for internalizing problems and externalizing problems. The prevalence of maternal social isolation was 25.4%. Maternal social isolation was associated with an increased risk of behavioral problems in children: the odds ratio (OR) was 1.37 (95% confidence interval [CI] 1.14-1.64). Maternal social isolation was also associated with increased risks of internalizing problems and externalizing problems in children: the ORs were 1.33 (95% CI, 1.12-1.59) and 1.40 (95% CI, 1.18-1.66), respectively. In conclusion, maternal social isolation one year after delivery was associated with behavioral problems in children at 4 years of age.

Antecedents and Consequences of Child Externalizing Problems: Differences in Dynamic Parent-Child Processes.

Given that noncompliance is the most common externalizing problem during middle childhood and reliably predicts significant conduct problems, innovations in elucidating its etiology are sorely needed. Evaluation of in-the-moment antecedents and consequences of child noncompliance improves traction on this goal, given that multiple theories contend that child noncompliance and parent behavior mutually influence each other through negative reciprocation as well as contingent praise processes. Among a sample of 140 families (child age: 6-10 years; 32.1% female), the present study capitalized on intensive repeated measures of observed child noncompliance and parent negative talk and praise objectively coded during three unique tasks. We employed dynamic structural equation modeling to evaluate within-dyad parent-child behavioral dynamics and between-dyad differences therein. Results provided mixed support for hypotheses and suggested that antecedents and consequences of child noncompliance differed according to task demands and child ADHD symptoms. Contrary to models of coercive cycles, during child-led play, parent negative talk was more likely following prior child noncompliance, but child noncompliance was less likely following prior parent negative talk. As expected, during parent-led play, parent praise was less likely following prior child noncompliance, which was also less likely following prior parent praise. Relative to youth with fewer symptoms, for children with elevated ADHD symptoms, during a challenging clean-up task, child noncompliance was less stable and less contingent on prior parent negative talk. Results are discussed in terms of their implications of real-time parent-child interactions for typical and atypical development of externalizing problems.

Factor Structure of the Teacher Strengths and Difficulties Questionnaire in a Large Community-Based Sample: An Investigation of Alternative Measurement Models.

The Strengths and Difficulties Questionnaire (SDQ) is a screening measure commonly used to assess behavioral and emotional symptoms and strengths among children and adolescents. However, despite its frequent use, its underlying factor structure remains an important area of inquiry. Whereas the original five-factor structure has often been supported through exploratory factor analysis, results from confirmatory analyses continue to yield mixed results. We analyzed data from youth in Grades K through 12 from a large epidemiologic study in the Southeastern United States. Teacher-report SDQ data were used to test three confirmatory factor models by school level (i.e., elementary [Grades K-5] and secondary [Grades 6-12]): The original five-factor model, a three-factor model, and a bifactor model. Model fit indices and reliability measures supported the original five-factor model as the preferred model when using the teacher-reported SDQ with both elementary and secondary school children. Implications for using the SDQ in applied research and predictive modeling are discussed.