Comparing Health Status, Health Trajectories and Use of Health and Social Services between Children with and without Developmental Disabilities: A Population-based Longitudinal Study in Manitoba.

BACKGROUND: Little information exists on health of children with developmental disabilities (DDs) in the Canadian province of Manitoba. METHOD: The present authors linked 12 years of administrative data and compared health status, changes in health and access to health and social services between children with (n = 1877) and without (n = 5661) DDs living in the province, matched by age, sex and region of residence. RESULTS: Children with DDs were significantly more likely than children in the matched comparison group to die before the age of 17 and have a history of respiratory illness, diabetes and injury-related hospitalizations. Children with DD also had significantly higher average number of ambulatory physician visits and higher rate of continuity of care. CONCLUSIONS: Children with DDs had poorer health status than the matched comparison group. The health disparities experienced by children with DDs persisted over time. Further population-based longitudinal research is needed in this area.

Depressogenic thinking and shame proneness in the development of internalizing problems.

This study examined depressogenic thinking and shame proneness as factors in the development of internalizing problems in a longitudinal sample of 174 children (99 boys, 75 girls). At 7.6-9.4 years of age (Time 1), mothers assessed general internalizing problems in their children and depressogenic thinking, shame proneness, and anxiety were assessed by child self report. At 10.2-11.8 years of age (Time 2), mothers reassessed internalizing problems, and children reported their anxiety and depression. At 12.3-13.1 years of age (Time 3), children who had been high on any Time 2 measure of internalizing problems were selected for assessment of anxiety and depressive disorders. Depressogenic thinking and shame were significantly correlated and predicted subsequent problems. Depressogenic thinking predicted internalizing problems and anxious and depressive symptoms. Shame directly predicted boys' depressive symptoms, and indirectly predicted boys' general internalizing problems and girls' social anxiety. Depressive disorders in early adolescence were predicted specifically by shame. Findings suggest that both shame and depressive thinking contribute to the development of children's internalizing problems.

Adrenocortical responses to strangers in preschoolers: relations with parenting, temperament, and psychopathology.

Previous research has provided inconsistent evidence for the relations between young children's hypothalamic-pituitary-adrenal (HPA) functioning and their temperament, parenting, and adjustment. Building biopsychosocial models of adjustment, we examined how temperamental inhibition and maternal punishment contributed to preschoolers' adrenocortical activity while interacting with adult strangers. We also examined whether HPA functioning moderated relations between dispositional and familial factors and children's internalizing and externalizing problems. A total of 402 preschool-aged children from three independent samples with parallel and overlapping measures were studied. Salivary cortisol levels were measured twice while interacting with adult strangers during testing protocols. Mothers reported on temperamental inhibition, maternal punishment and children's problems. Maternal punishment predicted higher cortisol levels 20 and 65 min after meeting adult strangers. Prolonged cortisol elevation was associated with having fewer externalizing problems. Boys who experienced more maternal punishment and had higher cortisol 20 min after meeting strangers manifested more externalizing problems. Girls who were more inhibited and had prolonged cortisol elevations had more internalizing problems. In accord with biopsychosocial models of psychopathology, HPA functioning in preschoolers was sensitive to variations in socialization experiences, and moderated children's risk for emotional and behavioral problems.

Cortisol reactivity and regulation associated with shame responding in early childhood.

The purpose of this study was to characterize cortisol response and regulation associated with shame responding in early childhood and to examine how general the relation between shame and cortisol is. It was predicted that children responding to task failure with shame would show a larger and more prolonged cortisol response than other children. Participants were 214 children (124 boys, 90 girls) ranging from 3.7 to 4.5 years of age (M = 4.14 years, SD = 0.24). Shame responding was assessed from children's emotion-expressive behavior in response to failing 6 performance tasks, 2 preceding (initial) and 4 following (subsequent) assessment of hypothalamic-pituitary-adrenal axis activation. Cortisol response and regulation associated with failure were assessed from saliva sampled before and 15, 20, 25, 30, and 40 min following the first of the 2 initial failures. For boys and for some girls, high initial shame was associated with greater cortisol reactivity and slower regulation of the cortisol response. For boys, high initial shame and relatively slow regulation of the associated cortisol response predicted subsequent shame responding occurring after recovery of the cortisol response. For girls, high initial shame, but not cortisol response, predicted subsequent shame responding.

Maternal and paternal depressive symptoms and child maladjustment: the mediating role of parental behavior.

This study examined parental behaviors as mediators in links between depressive symptoms in mothers and fathers and child adjustment problems. Participants were 4,184 parents and 6,048 10- to 15-year-olds enrolled in the 1998 and 2000 cycles of the Canadian National Longitudinal Survey of Children and Youth. Mothers and fathers self-reported symptoms of depression at Times 1 and 2 and their children assessed parental nurturance, rejection, and monitoring and self-reported internalizing and externalizing problems and prosocial behavior at Time 2. Hierarchical linear modeling showed evidence of mediation involving all three domains of parental behavior. Findings supported the hypothesis that the quality of the child's rearing environment is one mechanism that carries risk to children of depressed parents. Interventions for parents whose symptoms of depression interfere with parenting responsibilities could help reduce the risk of some childhood disorders.

Dispositional and Environmental Predictors of the Development of Internalizing Problems in Childhood: Testing a Multilevel Model.

This investigation evaluated a multilevel model of dispositional and environmental factors contributing to the development of internalizing problems from preschool-age to school-age. In a sample of 375 families (185 daughters, 190 sons) drawn from three independent samples, preschoolers' behavioral inhibition, cortisol and gender were examined as moderators of the links between mothers' negative parenting behavior, negative emotional characteristics, and socioeconomic status when children were 3.95 years, and their internalizing problems when they were 8.34 years. Children's dispositional characteristics moderated all associations between these environmental factors and mother-reported internalizing problems in patterns that were consistent with either diathesis-stress or differential-susceptibility models of individual-environment interaction, and with gender models of developmental psychopathology. Greater inhibition and lower socioeconomic status were directly predictive of more teacher reported internalizing problems. These findings highlight the importance of using multilevel models within a bioecological framework to understand the complex pathways through which internalizing difficulties develop.

Listening to parents: the challenges of parenting kindergarten-aged children who are anxious.

The purpose of this study was to increase understanding of the experience of parenting kindergarten-aged children who are anxious. Twenty-three in-depth interviews were conducted with parents of kindergarten-aged children who expressed interest in a parent-focused early intervention program for child anxiety offered in a local elementary school. Key concerns of the parents included their children's separation anxiety, social anxiety, and oppositional behaviour. The child's anxiety was identified as a stressor on the child, the parent, and the family. Parents utilized a range of parenting responses although they tended to be reactive and did not have a consistent strategy for managing the anxiety. A salient parenting struggle was whether or not to push the child to face challenging situations although there were few descriptions of overprotection or overcontrol. The findings suggest greater attention be given to the strengths of parents of children who are anxious and the ways in which parents may be a positive factor in mitigating the effects of child anxiety. Implications for intervention are discussed.