Parents' use of harsh punishment and young children's behaviour and achievement: a longitudinal study of Jamaican children with conduct problems.

INTRODUCTION: Harsh punishment by parents is common in low- and middle-income countries (LMIC), yet there is limited evidence from LMIC of the effects of harsh punishment on child outcomes. METHODS: A longitudinal, prospective study was conducted with children with conduct problems to examine the associations between parents' use of harsh punishment during the preschool years on child behaviour and school achievement in grade one of primary school. As part of an efficacy trial in 24 preschools, 225 children with the highest level of teacher-reported conduct problems were evaluated and their parents reported on how often they used harsh punishment. Outcome measures in grade one included child conduct problems by independent observation, teacher and parent report, child social skills by teacher and parent report, direct tests of children's academic achievement and language skills, and tester ratings of child attention and impulse control. RESULTS: Children had a mean age of 6.92 years and 61% were boys. All parents reported using harsh punishment. After controlling for child age and sex, socio-economic status, parents' involvement with child and maternal education, frequency of harsh punishment was associated with growth in child conduct problems by independent classroom observations (p  =  0.037), parent (p  =  0.018) and teacher (p  =  0.044) report, a reduction in child social skills by teacher (p  =  0.024) and parent (p  =  0.014) report and poorer attention during the test session (p  =  0.049). CONCLUSION: The associations between frequency of parents' use of harsh punishment with their preschoolers with conduct problems and later child behaviour indicate a need to train parents in non-violent behaviour management.

Effect of transporting an evidence-based, violence prevention intervention to Jamaican preschools on teacher and class-wide child behaviour: a cluster randomised trial.

INTRODUCTION: Based on extensive piloting work, we adapted the Incredible Years (IY) teacher-training programme to the Jamaican preschool setting and evaluated this adapted version through a cluster-randomised trial. METHODS: Twenty-four community preschools in Kingston, Jamaica were randomly assigned to intervention (12 schools, 37 teachers) or control (12 schools, 36 teachers). The intervention involved training teachers in classroom management through eight full-day training workshops and four individual 1-h in-class support sessions. Outcome measurements included direct observation of teachers' positive and negative behaviours to the whole class and to high-risk children and four observer ratings: two measures of class-wide child behaviour and two measures of classroom atmosphere. Measures were repeated at a six-month follow-up. RESULTS: Significant benefits of intervention were found for teachers' positive [effect size (ES) = 3.35] and negative (ES = 1.29) behaviours to the whole class and to high-risk children (positive: ES = 0.83; negative: ES = 0.50) and for observer ratings of class-wide child behaviour (ES = 0.73), child interest and enthusiasm (ES = 0.98), teacher warmth (ES = 2.03) and opportunities provided to share and help (ES = 5.72). At 6-month follow-up, significant benefits of intervention were sustained: positive behaviours (ES = 2.70), negative behaviours (ES = 0.98), child behaviour (ES = 0.50), child interest and enthusiasm (ES = 0.78), teacher warmth (ES = 0.91), opportunities to share and help (ES = 1.42). CONCLUSIONS: The adapted IY teacher-training programme produced large benefits to teacher's behaviour and to class-wide measures of children's behaviour, which were sustained at 6-month follow-up. Benefits were of a similar magnitude to those found in a pilot study of the minimally adapted version that required significantly more in-class support for teachers.

The Incredible Years Parent-Toddler Programme and parental language: a randomised controlled trial.

BACKGROUND: Parental language is associated with children's later language development. Parenting programmes, based on social learning theory, enhance a range of parenting behaviours, yet there is limited evidence for their effect on parental language. AIM: To assess the benefits of a behavioural-based parenting programme, which features components of language and communication, to enhance parental language. METHOD: Parents of toddlers, aged 12 to 36 months, were recruited from eight Flying Start early intervention centres across Wales. Participants were randomised 2:1 either to a parenting programme (n = 60) or to a wait-list control group (n = 29). Researchers were blind to participant allocation throughout the trial. Fifteen-minute video-recorded observations of parents and children interacting during free-play, both at a pre-intervention and at 6-month follow-up, provided the data for the study. Five observed measures of parental language were assessed; quantity and variety, encouraging, critical, child-led and parent led interactions. INTERVENTION: The Incredible Years Parent-Toddler Programme (IYPTP) is a 12-week group-based behavioural intervention that teaches effective relationship and behavioural management skills including social, emotional and persistence coaching to enable parents to better support their children's development. RESULTS: Of 89 dyads that completed pre-intervention assessments 81 (54 intervention and 27 control) met the criteria for the current study. Intention to treat analysis indicated that child-led language interactions significantly benefited from the intervention [regression coefficient (B) = -1.44, 95% confidence intervals (CI) = -2.59 to -0.29, P = 0.015, effect size (ES) = 0.47] and a positive trend for encouraging language in favour of the intervention sample was evident. Per-protocol sample analysis replicated these findings with encouraging language reaching statistical significance (B = 1.07, 95% CI = 0.11 to 2.03, P = 0.03, ES = 0.52). No further benefits were evident. CONCLUSIONS: The IYPTP has limited evidence as an effective programme for enhancing some aspects of parental language.

A parenting intervention delivered at routine primary health visits improved child cognitive development and parenting knowledge

OBJECTIVE: Several agencies have recommended integrating early child development interventions with health services. We developed and evaluated a parent training programme integrated into primary health visits. DESIGN AND METHODS: A cluster randomised trial conducted in Jamaica, Antigua and St Lucia with health centre as the unit of randomization. Fifteen centres were randomised to control (n=250 mother-child pairs) and 14 to intervention (n=251). Participants were recruited at the 6-8 week child health visit. Intervention was provided at routine health visits from age 3-18 months and comprised short films of child development messages followed by discussion and demonstration led by community health workers, and mothers’ practice of activities. Nurses distributed message cards and a few play materials. Primary outcomes were child development, measured 2 weeks after the 18 month visit, with the Griffiths Mental Development Scales and the Communicative Development Inventory (CDI). RESULTS: 85% of enrolled children were tested (control = 210; intervention=216). Loss did not differ by group. Multilevel analyses showed significant intervention benefits for cognitive development, (3.09 points; 95% CI 1.31, 4.87), effect size 0.30 SD. There were no benefits to language or hand and eye subscales, or CDI vocabulary score. Of six secondary outcomes there was a significant benefit to parenting knowledge, treatment effect 1.59 (95% CI 1.01 to 2.17), effect size 0.40. CONCLUSION: An innovative parenting intervention, requiring no additional clinic staff or mothers’ time, can be integrated into health services, with benefits to cognitive development and parent knowledge.

Building human capacity through early childhood intervention: the Child Development Research Programme at the Tropical Medicine Research Institute, the University of the West Indies, Kingston, Jamaica.

Research conducted by the Child Development Research Group in the Tropical Medicine Research Institute has made significant contributions to the understanding of the importance of early nutrition and the home environment for children's development and the impact of psychosocial stimulation for disadvantaged and/or undernourished children. The work has provided critical evidence that has contributed to the increasing attention given to early childhood development in the work and policies of agencies such as the World Bank, World Health Organization (WHO) and United Nations Children Fund (UNICEF). This review concerns research which documented the impact of malnutrition on children's development and for the first time demonstrated the benefits and necessity of psychosocial stimulation for improvement in development. Subsequent research was critical in establishing the importance of linear growth retardation (stunting) as a risk factor for poor child development. A twenty-two-year study of stunted children has demonstrated benefits through to adulthood in areas such as educational attainment, mental health and reduced violent behaviour from an early childhood home visiting programme that works through mothers to promote their children's development. The group's research has also demonstrated that it is feasible and effective to integrate the stimulation intervention into primary care services with benefits to children's development and mothers'child rearing knowledge and practices. The group is currently conducting a study to provide information needed for scaling-up of parenting programmes through evaluation of a new approach to improving parenting through health centres and a modified home visit programme.

Building human capacity through early childhood intervention: the Child Development Research programme at the Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica / Construcción de la capacidad humana mediante intervención en la primera infancia: Programa de Investigación del Desarrollo Infantil en el Instituto de Investigación de Medicina Tropical, Universidad de West Indies, Kingston, Jamaica

Research conducted by the Child Development Research Group in the Tropical Medicine Research Institute has made significant contributions to the understanding of the importance of early nutrition and the home environment for children's development and the impact of psychosocial stimulation for disadvantaged and/or undernourished children. The work has provided critical evidence that has contributed to the increasing attention given to early childhood development in the work and policies of agencies such as the World Bank, World Health Organization (WHO) and United Nations Children Fund (UNICEF). This review concerns research which documented the impact of malnutrition on children's development and for the first time demonstrated the benefits and necessity of psychosocial stimulation for improvement in development. Subsequent research was critical in establishing the importance of linear growth retardation (stunting) as a risk factor for poor child development. A twenty-two-year study of stunted children has demonstrated benefits through to adulthood in areas such as educational attainment, mental health and reduced violent behaviour, from an early childhood home visiting programme that works through mothers to promote their children's development. The group's research has also demonstrated that it is feasible and effective to integrate the stimulation intervention into primary care services with benefits to children's development and mothers' child rearing knowledge and practices. The group is currently conducting a study to provide information needed for scaling-up of parenting programmes through evaluation of a new approach to improving parenting through health centres and a modified home visit programme.

Una investigación dirigida por el Grupo de Investigación del Desarrollo Infantil en el Instituto de Investigación de Medicina Tropical, ha contribuido de manera significativa a comprender, por una parte, la importancia que tanto la nutrición temprana como el ambiente hogareño poseen para el desarrollo infantil de niños, y por otra parte, el impacto de la estimulación psicosocial para los niños desfavorecidos y/o desnutridos. La evidencia crítica ofrecida por este trabajo ha hecho que se le conceda mayor atención al desarrollo de la primera infancia en el trabajo y las políticas de agencias como el Banco Mundial, la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (UNICEF). Este estudio trata de una investigación que documenta el impacto de la desnutrición en el desarrollo de niños, y por primera vez demuestra los beneficios y la necesidad de la estimulación psicosocial para favorecer el desarrollo. La investigación subsiguiente fue decisiva para establecer la importancia del retraso del crecimiento linear (RCL) como un factor de riesgo para el desarrollo del niño pobre. Un estudio de veintidós años sobre niños con retraso en el crecimiento ha demostrado los beneficios hasta llegar a la adultez, en áreas como la educación, la salud mental y la reducción del comportamiento violento, a partir de un programa de visita a hogares de la primera infancia, que trabaja con las madres para promover el desarrollo de sus hijos.

FACTORS ASSOCIATED WITH INTERNALISING PROBLEMS IN ORPHANS AND THEIR CAREGIVERS IN RURAL MOZAMBIQUE.

OBJECTIVES: To compare internalising problems reported by orphans and their caregivers with that of non-orphans and their caregivers. DESIGN: Case control study. SETTING: Cahora-Bassa District of Tete, Mozambique SUBJECTS: Seventy-six maternal or double orphans (aged 10-14 years) and their caregivers were compared with seventy-four non-orphans and their caregivers living in the same neighbourhood. MAIN OUTCOME MEASURES: children were interviewed with a semi-structured questionnaire concerning their internalising problems, family structure, school attendance, daily experiences and perceived problems. The children's primary caregivers were also interviewed concerning their depressive symptoms, available social support, socio-economic conditions and perceived problems. RESULTS: Orphans lived in poorer households than non-orphans and reported more internalising symptoms and more economic and psychosocial disadvantages. Orphan caregivers were more depressed and had less social support than non-orphan caregivers. Child internalising symptoms were independently associated with bullying (B = 8.04, 95% CI: 0.24,15.85), perceived undeserved punishment (B = 11.98, 95% CI: S.98,17.98) and orphan status (B = 33.36, 95% CI: 26.67, 40.05). The effect of punishment was stronger for orphans than non-orphans. Frequency of hunger affected internalising symptoms only in orphans. Caregiver depression was independently associated with low social support (B = -0.35, 95% CI: -0.51, -0.18), few possessions (B = -2.10, 95% CI: -3.42, -0.79) an orphan status (B = 4.54, 95% CI: 3.30, 5.78) and possessions had a stronger effect in orphan caregivers. Quality of housing caused depression only in caregivers of orphans. CONCLUSION: Both orphans and their caregivers were more depressed than the non-orphans and their caregivers. They were exposed to more economic and psychosocial disadvantages and were more vulnerable to risks.

Transporting evidence-based interventions across cultures: using focus groups with teachers and parents of pre-school children to inform the implementation of the Incredible Years Teacher Training Programme in Jamaica.

BACKGROUND: Evidence-based programmes to prevent and treat conduct problems in young children are available, but there is limited information on the extent to which they can be effectively transported to developing countries. This study used focus group discussions with parents and teachers of pre-school children to investigate whether an evidence-based programme - the Incredible Years (IY) Teacher Training Programme - could be transported to the Jamaican pre-school setting. METHODS: Ten focus group discussions were held with 50 pre-school teachers and 47 parents of pre-school children. For each focus group, a semi-structured questioning guide was used to explore parents' and teachers' perceptions of the dimensions and causes of problem behaviour in young children and strategies used to manage child behaviour. All focus group discussions were audiotaped and transcribed, and thematic analysis was used to analyse the data. RESULTS: Parents and teachers shared similar views of what constitutes good behaviour and poor behaviour, and both parents and teachers believed that the major influences on children's behaviour are factors in the home. Many appropriate and useful strategies for managing child behaviour were used including showing children affection, spending time with children, using praise, incentives and rewards and withdrawing privileges and using timeout as consequences for misbehaviour. Some inappropriate strategies were also used, especially corporal punishment, although there was a general consensus within all groups that this is not desirable or effective. CONCLUSIONS: Through the focus groups, it was clear that parents and teachers were familiar with many of the strategies and principles introduced through the IY Teacher Training Programme, and the programme was largely compatible with their values and beliefs. However, some topics require additional emphasis thus lengthening the time required for training. It was also evident that there is a strong perceived need for training in child behaviour management for parents.

Preventing behaviour problems through a universal intervention in Jamaican basic schools: a pilot study / Prevención de los problemas de comportamiento a través de una intervención universal en las escuelas preescolares de Jamaica: un estudio piloto

OBJECTIVE: To evaluate the effect of a preventative intervention in Jamaican basic schools on child behaviour and parent-teacher contacts. DESIGN AND METHODS: Five basic schools in Kingston, Jamaica, were randomly assigned to an intervention (n = 3) or control (n = 2) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training Programme supplemented by fourteen lessons on social and emotional skills in each class. Within each classroom (n = 27), children were screened for behaviour difficulties through teacher report and children with the greatest difficulties were selected for evaluation of outcomes (135 children). Teachers' reports of child behaviour using the Strengths and Difficulties Questionnaire and of the quality of teacher-parent contacts were collected at the beginning and end of the school year. Multilevel regression analyses controlling for school and classroom were used to evaluate the effects of intervention on child behaviour. RESULTS: Significant benefits of intervention were found for children's conduct problems (regression coefficient (b) = -0.62, 95% confidence interval (CI): -0.01, -1.23), hyperactivity (b = -0.84, 95% CI: -1.57, -0.11) and peer problems (b = -1.24, 95% CI: -1.89, -0.59). The effect sizes were 0.26 for conduct problems, 0.36 for hyperactivity and 0.71 for peer problems. No significant benefits were found for the prosocial and emotional problems subscales. The intervention also resulted in increases in the number of positive teacher-parent contacts (p < 0.0001). No benefits were found for the number of negative teacher-parent contacts. CONCLUSION: This is a promising approach for reducing children's externalizing behaviour and peer problems and for improving the quality of teachers' contacts with parents of children with behaviour problems.

OBJETIVO: Evaluar el efecto de una intervención preventiva en el comportamiento de los niños y los contactos entre padres y maestros en las escuelas preescolares de Jamaica. DISEÑO Y MÉTODOS: Cinco escuelas preescolares en Kingston, Jamaica, fueron asignadas de manera aleatoria a una intervención (n = 3) o condición de control (n = 2). La intervención comprendió siete talleres de maestro el día entero, usando el Programa de Entrenamiento de Maestros "Años Increíbles", complementado por catorce lecciones sobre habilidades sociales y emocionales en cada clase. Dentro de cada aula (n = 27), se realizó un pesquisaje de niños en busca de dificultades en la conducta a través del informe del maestro, y los niños con las mayores dificultades fueron seleccionados para la evaluación de resultados (135 niños). Informes de los maestros sobre la conducta de los niños - realizados mediante el Cuestionario de fortalezas y dificultades, y sobre la calidad de los contactos entre maestros y padres - fueron recogidos al inicio y al final del año escolar. Análisis de regresión multinivel para el control de la escuela y el aula, fueron usados para evaluar los efectos de la intervención sobre el comportamiento de los niños. RESULTADOS: Se hallaron beneficios significativos para los problemas de la conducta de los niños (coeficiente de regresión (b) = -0.62, 95% intervalo de confianza (IC): -0.01, -1.23), hiperactividad (b = -0.84, 95% IC: -1.57, -0.11) y problemas con los iguales (b = -1.24, 95% IC: -1.89, -0.59). Los tamaños de efecto fueron 0.26 para los problemas de conducta, 0.36 para la hiperactividad y 0.71 para los problemas de iguales. No se hallaron beneficios significativos para las subescalas de problemas prosociales y emocionales. La intervención también trajo como resultado aumentos en el número de contactos positivos entre maestros y padres (p < .0001). No se hallaron beneficios para el número de contactos negativos maestros-padres. CONSLUSIÓN: Este trabajo representa un abordaje prometedor a la hora de reducir la conducta externalizadora de los niños y los problemas de iguales, así como para mejorar la calidad de los contactos entre los maestros y los padres de los niños con problemas de conducta.

A qualitative study of teacher's perceptions of an intervention to prevent conduct problems in Jamaican pre-schools.

BACKGROUND: There is a growing evidence base showing the efficacy of school-based interventions to prevent conduct problems but few evaluations have addressed teachers' perceptions of these programmes. Teachers' views on the acceptability, feasibility and usefulness of an intervention will influence implementation fidelity and programme sustainability and can help further our understanding of how the intervention works and how it may be improved. METHODS: A pilot study of the Incredible Years Teacher Training Programme supplemented by a curriculum unit on social and emotional skills was conducted in inner-city pre-schools in Kingston, Jamaica. Three pre-schools comprising 15 classrooms participated in the intervention which involved seven monthly teacher workshops and 14 weekly child lessons in each class. At the end of the intervention in-depth individual interviews were conducted with each intervention teacher. RESULTS: Teachers reported benefits to their own teaching skills and professional development, to their relationships with children and to the behaviour, social-emotional competence and school readiness skills of the children in their class. Teachers also reported benefits to teacher-parent relationships and to children's behaviour at home. A hypothesis representing the teachers' perceptions of how the intervention achieved these benefits was developed. The hypothesis suggests that intervention effects were due to teachers' gains in skills and knowledge in three main areas: (1) a deeper understanding of young children's needs and abilities; (2) increased use of positive and proactive strategies; and (3) explicitly teaching social and emotional skills. These changes then led to the variety of benefits reported for teachers, children and parents. Teachers reported few difficulties in implementing the majority of strategies and strongly recommended wider dissemination of the intervention. CONCLUSIONS: The intervention was valued by Jamaican pre-school teachers and teachers felt they were able to successfully integrate the strategies learned into their regular practice.

A pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills in community pre-schools in Jamaica.

BACKGROUND: School-based interventions involving teacher and/or child training have been shown to benefit teacher practices and to prevent conduct problems and improve children's social and emotional competence in developed countries; however, we are aware of no reports from a developing country. We conducted a pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills based on concepts and activities drawn from the Incredible Years Dina Dinosaur Classroom Curriculum to determine if this approach is appropriate for use with Jamaican pre-school teachers and children. METHODS: Five pre-schools in Kingston, Jamaica were randomly assigned to an intervention (3 pre-schools with 15 classrooms) or control (2 pre-schools with 12 classrooms) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training programme supplemented by 14 child lessons in each class. The project was evaluated through structured observations of four categories of teacher behaviour and four observer ratings: two rating scales of child behaviour and two rating scales of classroom atmosphere. RESULTS: Significant intervention benefits were found to teachers' behaviour with increased positive behaviour [b = 7.9; 95% confidence interval (CI): 3.5, 12.3], reduced negative behaviour (b =-3.5; 95% CI: -6.6, -0.2) and increases in the extent to which teachers promoted children's social and emotional skills (b = 46.4; 95% CI: 11.0, 81.7). The number of teacher commands was not significantly reduced (b =-2.71; 95% CI: -6.01, 0.59). Significant intervention benefits were found to ratings of child behaviour with an increase in children's appropriate behaviour (b = 5.7, 95% CI: 1.0, 10.8) and in children's interest and enthusiasm (b = 7.2, 95% CI: 0.9, 13.5). Intervention also benefited classroom atmosphere with increases in opportunities provided for children to share and help each other (b = 1.3, 95% CI: 0.5, 2.1) and in teacher warmth (b = 1.3, 95% CI: 0.9, 1.8). CONCLUSION: This is a promising approach for improving the emotional climate of Jamaican pre-school classrooms and for improving child behaviour and participation.

Preventing behaviour problems through a universal intervention in Jamaican basic schools: a pilot study.

OBJECTIVE: To evaluate the effect of a preventative intervention in Jamaican basic schools on child behaviour and parent-teacher contacts. DESIGN AND METHODS: Five basic schools in Kingston, Jamaica, were randomly assigned to an intervention (n = 3) or control (n = 2) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training Programme supplemented by fourteen lessons on social and emotional skills in each class. Within each classroom (n = 27), children were screened for behaviour difficulties through teacher report and children with the greatest difficulties were selected for evaluation of outcomes (135 children). Teachers'reports of child behaviour using the Strengths and Difficulties Questionnaire and of the quality of teacher-parent contacts were collected at the beginning and end of the school year Multilevel regression analyses controlling for school and classroom were used to evaluate the effects of intervention on child behaviour. RESULTS: Significant benefits of intervention were found for children's conduct problems (regression coefficient (b) = -0.62, 95% confidence interval (CI): -0.01, -1.23), hyperactivity (b = -0.84, 95% CI: -1.57, -0.11) and peer problems (b = -1.24, 95% CI: -1.89, -0.59). The effect sizes were 0.26 for conduct problems, 0.36 for hyperactivity and 0.71 for peer problems. No significant benefits were found for the prosocial and emotional problems subscales. The intervention also resulted in increases in the number of positive teacher-parent contacts (p < 0.0001). No benefits were found for the number of negative teacher-parent contacts. CONCLUSION: This is a promising approach for reducing children's externalizing behaviour and peer problems and for improving the quality of teachers' contacts with parents of children with behaviour problems.

The effect of early stimulation on maternal depression: a cluster randomised controlled trial.

AIM: To determine the effect of early childhood stimulation with undernourished children and their mothers on maternal depression. METHODS: Mothers of 139 undernourished children (weight for age < or =-1.5 z-scores) aged 9-30 months were recruited from 18 government health centres in the parishes of Kingston, St Andrew, and St Catherine, Jamaica. They received weekly home visits by community health aides for one year. Mothers were shown play activities to do with their child using home made materials, and parenting issues were discussed. Frequency of maternal depressive symptoms was assessed by questionnaire. Child development was also measured. RESULTS: Mothers in the intervention group reported a significant reduction in the frequency of depressive symptoms (b = -0.98; 95% CI -1.53 to -0.41). The change was equivalent to 0.43 SD. The number of home visits achieved ranged from 5 to 48. Mothers receiving > or =40 visits and mothers receiving 25-39 visits benefited significantly from the intervention (b = -1.84, 95% CI -2.97 to -0.72, and b = -1.06, 95% CI -2.02 to -0.11, respectively) while mothers receiving <25 visits did not benefit. At follow up, maternal depression was significantly negatively correlated with children's developmental quotient for boys only. CONCLUSIONS: A home visiting intervention with mothers of undernourished children, with a primary aim of improving child development, had significant benefits for maternal depression. Higher levels of maternal depression were associated with poorer developmental levels for boys only.

Mothers of undernourished Jamaican children have poorer psychosocial functioning and this is associated with stimulation provided in the home.

OBJECTIVES: To compare mothers of undernourished children with mothers of adequately nourished children on maternal depression, parenting self-esteem, social support and exposure to stressors and to determine if these variables are independently related to undernutrition and stimulation provided in the home after controlling for socio-economic status. DESIGN: A case control study. SETTING: Children and their mothers were recruited from 18 government health centres in the Kingston, St Andrew and St Catherine parishes of Jamaica. SUBJECTS: One hundred and thirty-nine mothers of undernourished children (WAZ< or =-1.5z scores) aged 9 - 30 months and 71 mothers of adequately nourished children (WAZ > -1z scores) matched for sex and age group were enrolled into the study. RESULTS: Mothers of undernourished children came from poorer homes but had similar social support to mothers of adequately nourished children. They were more depressed, had lower levels of parenting self-esteem (both P<0.01), reported higher levels of economic stress (P<0.001) and provided a less stimulating home environment (P<0.05). However, after controlling for social background variables there was no independent relationship between either psychosocial function or home stimulation and nutritional status. Undernutrition was found to be mainly explained by economic factors. The mothers' self-esteem was independently associated with the level of stimulation provided to the child. CONCLUSIONS: When caring for undernourished children attention should be paid to the psychosocial status of the mother as well as the physical condition of the child. SPONSORSHIP: Thrasher Research Fund; Campus Research and Publication Fund, UWI, Jamaica.